| NPI | 1003025560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE S PORTNOFF President 314-993-2909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO R9730) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO R9730) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MO R9730) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-09-20 |