Provider Demographics
NPI:1437229531
Name:DERMATOLOGY HEALTH CENTER INC
Entity Type:Organization
Organization Name:DERMATOLOGY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-878-2556
Mailing Address - Street 1:224 SO WOODSMILL ROAD
Mailing Address - Street 2:SUITE 570 SO
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-878-2556
Mailing Address - Fax:314-275-7442
Practice Address - Street 1:224 SO WOODSMILL ROAD
Practice Address - Street 2:SUITE 570 SO
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-878-2556
Practice Address - Fax:314-275-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35270207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1147990001340Medicare ID - Type Unspecified
A24081Medicare UPIN