Organization
MID-COUNTY DERMATOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CONNIE GIBSTINE M.D. (MANAGER)
(314) 994-0200
Entity
Organization
Contact information
Practice address
3009 N BALLAS RD, STE 208B, SAINT LOUIS, MO 63131-2322
(314) 994-0200
(314) 994-7945
Mailing address
3009 N BALLAS RD, STE 208B, SAINT LOUIS, MO 63131-2322
(314) 994-0200
(314) 994-7945
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000012915
MEDICARE LEGACY NUMBER
MO
Enumeration date
02/04/2008
Last updated
01/20/2009
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