# CENTRAL MISSOURI DERMATOLOGY ASSOC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699663849
- **Authorized official:** TIFFANY MARTIN (BILLING MANAGER)
- **Authorized official phone:** (573) 876-1616

## Contact information

- **Practice address:** 401 N KEENE ST, COLUMBIA, MO 65201-6625
- **Practice address phone:** (573) 876-1616
- **Practice address fax:** (573) 876-1678
- **Mailing address:** 401 N KEENE ST, COLUMBIA, MO 65201-6625
- **Mailing address phone:** (573) 876-1616
- **Mailing address fax:** (573) 876-1678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/26/2025
- **Last updated:** 06/26/2025