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General NPI Number Information
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NPI Number | 1043462591
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY OFFICE PC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1600 W HARPER ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-4119
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Country | US
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Telephone | 573-686-4750
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Fax | 573-686-4753
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Provider Business Mailing Address
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Address Line | 1600 W HARPER ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-4119
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Country | US
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Telephone | 573-686-4750
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | VANESSA ADAMS
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Credential |
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Telephone | 573-686-4750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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