# ALLIANCE HEALTH & DERMATOLOGY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** c/o Ramiro Icaza
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790818599
- **Authorized official:** MR. RAMIRO ICAZA M.D. (ADMINISTRATOR)
- **Authorized official phone:** (573) 243-2154

## Contact information

- **Practice address:** 304 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4920
- **Practice address phone:** (573) 803-3331
- **Practice address fax:** (573) 803-2905
- **Mailing address:** 304 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4920
- **Mailing address phone:** (573) 803-3331
- **Mailing address fax:** (573) 243-3400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MDR7D79 | MO | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 02/06/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 593695703 | — | MO |