ST LOUIS DERMATOLOGY LLC (NPI# 1760810543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760810543 |
| Entity Type | Organization |
| Organization Name | ST LOUIS DERMATOLOGY LLC |
| Practice Address |
1011 Bowles Avenue Suite 121 Fenton MO 63026-2387 |
| Practice Telephone | 3142002713 |
| Practice Fax Number | 3142002714 |
| Mailing Telephone | 3142002713 |
| Mailing Fax Number | 3142002714 |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2014-02-18 |
| Authorized Official Name | JEFFREY E PETERSEN (OWNER) |
| Authorized Official Telephone | 3142002713 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 2001020599 | MO | Allopathic & Osteopathic Physicians |
| Street Address |
1011 BOWLES AVENUE SUITE 121 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-2387 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104872068 | Timothy James Pratt | Internal Medicine | 1011 Bowles Avenue, Suite 121, Fenton, MO 63026 | 2006-05-25 |
| 1073903134 | Anastasia A Averbukh | Nurse Practitioner | 1011 Bowles Avenue, Suite 121, Fenton, MO 63026-2387 | 2015-01-28 |
| 1831335819 | Ankle and Foot Institute of Missouri P.C. | Podiatrist | 1011 Bowles Avenue, Suite 123, Fenton, MO 63026 | 2008-12-23 |
| 1871617993 | Allison K Davis | Surgery | 1011 Bowles Avenue, Suite 425, Fenton, MO 63026 | 2007-03-16 |
| 1215943105 | Richard Felix Wittock IIi | Podiatrist | 1011 Bowles Avenue, Suite 123, Fenton, MO 63026 | 2006-07-31 |
| 1124046354 | Edward Reh | Internal Medicine | 1011 Bowles Avenue, Suite 300, Fenton, MO 63026-2387 | 2006-07-17 |
| 1295768323 | Douglas Dripps | Internal Medicine | 1011 Bowles Avenue, Suite 300, Fenton, MO 63026-2387 | 2006-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
| Find all providers in zip 63026 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912904772 | Eric Scott Seiger | Dermatology | 305 N Leroy St, Fenton, MI 48430-2729 | 2005-07-07 |
| 1093129538 | Elizabeth Anne Rancour | Dermatology | 1011 Bowles Ave, Ste 121, Fenton, MO 63026 | 2014-06-12 |
| 1275551707 | Jeffrey E Petersen | Dermatology | 1011 Bowles Ave, Suite 121, Fenton, MO 63026-2395 | 2006-07-17 |
| 1174565600 | Svc Dermatology PC | Dermatology | 305 N Leroy St, Fenton, MI 48430-2729 | 2006-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922605906 | Deluxe Dermatology LLC | Dermatology | 1034 S Brentwood Blvd Ste 1000, Saint Louis, MO 63117-1210 | 2020-10-03 |
| 1811510886 | Yoon Dermatology LLC | Dermatology | 1060 Meyer Rd, Wentzville, MO 63385-3800 | 2020-05-25 |
| 1417597923 | Anna Marie Aiazzi | Dermatology | 10012 Kennerly Rd Ste 401, Saint Louis, MO 63128-2197 | 2020-01-13 |
| 1790330371 | Baydon Earl Hilton | Dermatology | 1003 Kings Rd, Kirksville, MO 63501-2627 | 2019-08-09 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1528537057 | Cayce Medical Spa, Inc | Dermatology | 2001 Corona Rd Ste 201, Columbia, MO 65203-5924 | 2018-11-14 |
| 1396226981 | Nicole Betty | Dermatology | 413 W Water Street, Greenfield, MO 65661 | 2018-08-22 |
| 1366946832 | Novahealth Medical Group, LLC | Dermatology | 3208 Lemone Industrial Blvd Ste A, Columbia, MO 65201-8244 | 2018-03-20 |
| 1952757007 | Stacy Gittel Blum | Dermatology | 222 S Woods Mill Rd Ste 480, Chesterfield, MO 63017-3625 | 2016-05-08 |
| 1508248576 | Kaitlin Ann Schiavo | Dermatology | 204 N Keene St Ste 100, Columbia, MO 65201-8136 | 2015-06-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.