Organization
ST CHARLES COUNTY DERMATOLOGIC SURGERY, LLC
Active
Organization
ST CHARLES COUNTY DERMATOLOGIC SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY S TULL MD (PHYSICIAN AND OWNER)
(636) 327-3376
Entity
Organization
Contact information
Practice address
1493 COTTLEVILLE PKWY, COTTLEVILLE, MO 63376-3564
(636) 317-3376
(636) 244-1197
Mailing address
1493 COTTLEVILLE PKWY, COTTLEVILLE, MO 63376-3564
(636) 317-3376
(636) 244-1197
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Enumeration date
02/06/2020
Last updated
02/06/2020
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