Provider Demographics
NPI:1275661589
Name:ERIC W PITTS DERMATOLOGY LLC
Entity Type:Organization
Organization Name:ERIC W PITTS DERMATOLOGY LLC
Other - Org Name:MIDWEST DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-953-6200
Mailing Address - Street 1:1224 GRAHAM ROAD
Mailing Address - Street 2:SUITE 1108
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031
Mailing Address - Country:US
Mailing Address - Phone:314-953-6200
Mailing Address - Fax:314-953-6203
Practice Address - Street 1:1224 GRAHAM ROAD
Practice Address - Street 2:SUITE 1108
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-953-6200
Practice Address - Fax:314-953-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty