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General NPI Number Information
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NPI Number | 1659594539
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN DERMATOLOGY AND CUTANEOUS SURGERY LTD
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 222 S WOODS MILL RD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3625
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Country | US
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Telephone | 314-576-1411
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Fax | 314-576-2850
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Provider Business Mailing Address
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Address Line | 222 S WOODS MILL RD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3625
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Country | US
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Telephone | 314-576-1411
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Fax | 314-576-2850
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES W DONNELLY
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Credential | M.D.
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Telephone | 314-576-1411
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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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