Provider Demographics
NPI:1760520639
Name:SUNSET DERMATOLOGY PC
Entity Type:Organization
Organization Name:SUNSET DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-842-6630
Mailing Address - Street 1:3844 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1368
Mailing Address - Country:US
Mailing Address - Phone:314-842-6630
Mailing Address - Fax:314-842-7543
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:314-842-6630
Practice Address - Fax:314-842-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty