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General NPI Number Information
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NPI Number | 1952958449
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Entity Type | Organization
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Legal Business Name | ALLIANCE HEALTH AND DERMATOLOGY, LLC
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 304 S MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4920
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Country | US
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Telephone | 573-803-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4920
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Country | US
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Telephone | 573-803-3331
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMANDA BECKER
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Credential |
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Telephone | 573-803-3331
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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