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General NPI Number Information
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NPI Number | 1336892850
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Entity Type | Organization
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Legal Business Name | ADMIRAL DERMATOLOGY LLC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 3808 S. GREYSTONE CT.
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City | SPRINGFIELD
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State | MO
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Zip | 65804
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Country | US
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Telephone | 417-889-3332
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Fax | 417-881-1410
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Provider Business Mailing Address
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Address Line | 3808 S. GREYSTONE CT.
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City | SPRINGFIELD
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State | MO
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Zip | 65804
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Country | US
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Telephone | 417-889-3332
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Fax | 417-881-1410
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE HAWKINS
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Credential |
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Telephone | 417-889-3332
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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