Provider Demographics
NPI:1205933546
Name:DERMATOLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-993-1714
Mailing Address - Street 1:2325 DOUGHERTY FERRY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3356
Mailing Address - Country:US
Mailing Address - Phone:314-993-1714
Mailing Address - Fax:314-993-1718
Practice Address - Street 1:2325 DOUGHERTY FERRY RD
Practice Address - Street 2:STE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3356
Practice Address - Country:US
Practice Address - Phone:314-993-1714
Practice Address - Fax:314-993-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36494207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000003218Medicare PIN
IL209692Medicare PIN
MOA10634Medicare UPIN
ILA10634Medicare UPIN