Organization
DERMATOLOGY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH M MALTERS MD (OWNER)
(573) 364-0122
Entity
Organization
Contact information
Practice address
10101 STOLTZ DR, ROLLA, MO 65401-7714
(573) 364-0122
(573) 364-0129
Mailing address
10101 STOLTZ DR, ROLLA, MO 65401-7714
(573) 364-0122
(573) 364-0129
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MO2001027199
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506121300
—
MO
Enumeration date
12/23/2006
Last updated
05/11/2019
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