Integrated Dermatology of Northeast Missouri LLC

NPI #1992518658 in Hannibal, Missouri

Provider Information

NPI Number: 1992518658
Entity Type: Organization
Organization Name: Integrated Dermatology of Northeast Missouri LLC
Primary Specialty: Dermatology
Enumeration Date: Jan 28, 2025
Last Updated: Jan 28, 2025

Practice Location

Address: 163 MEDICAL DR
City: Hannibal
State: Missouri
ZIP Code: 63401-6884
Phone: (573) 719-1818

Authorized Official

Name: JEFFREY QUEEN
Title: AUTHORIZED OFFICIAL
Phone: (561) 231-2635

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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