| NPI | 1992518658 |
|---|---|
| Former Legal Business Name | INTEGRATED DERMATOLOGY OF NORTHEAST MISSOURI LLC |
| Entity Type | Organization |
| Authorized Contact | JEFFREY QUEEN Authorized Official 561-231-2635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2025-01-28 |