St Louis Dermatology LLC

NPI #1760810543 in Fenton, Missouri

Provider Information

NPI Number: 1760810543
Entity Type: Organization
Organization Name: St Louis Dermatology LLC
Primary Specialty: Dermatology
Enumeration Date: Oct 14, 2013
Last Updated: Feb 18, 2014

Practice Location

Address: 1011 BOWLES AVENUE
Address 2: SUITE 121
City: Fenton
State: Missouri
ZIP Code: 63026-2387
Phone: (314) 200-2713

Authorized Official

Name: JEFFREY E PETERSEN, MD
Title: OWNER
Phone: (314) 200-2713

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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