| NPI | 1982897450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN SCOTT GARDNER Physician/Owner 314-849-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2001005039) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2001005039) |
| 207ND0900X Dermatology, Dermatopathology (Licence: MO 2001005039) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: MO 2001005039) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MO 2001005039) | |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2009-08-27 |