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General NPI Number Information
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NPI Number | 1154593374
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND SURGERY PC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 123 S MAIN ST
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City | NEVADA
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State | MO
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Zip | 64772-3363
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Country | US
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Telephone | 515-210-4855
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Fax | 515-241-2013
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Provider Business Mailing Address
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Address Line | 5910 ASHWORTH RD # 222
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City | WEST DES MOINES
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State | IA
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Zip | 50266-7108
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Country | US
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Telephone | 515-210-4855
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Fax | 515-241-2013
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW K BEAN
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Credential | MD
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Telephone | 515-210-4855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2008006946
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License Number State | MO
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