Organization
EPIPHANY DERMATOLOGY OF MISSOURI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHEORGHE PUSTA (CEO)
(512) 628-0465
Entity
Organization
Contact information
Practice address
2325 DOUGHERTY FERRY RD STE 201, SAINT LOUIS, MO 63122-3356
(314) 993-1714
Mailing address
7300 RANCH RD. 2222, BLDG 1, STE 200, AUSTIN, TX 78730-2309
(512) 628-0465
(512) 628-0468
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
12/04/2017
Last updated
12/07/2023
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