Organization
DERMATOLOGY CARE CENTER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DOBBIN CONNOR M.D. (PRESIDENT)
(618) 288-0998
Entity
Organization
Contact information
Practice address
22 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5669
(618) 288-0998
(618) 288-9934
Mailing address
22 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5669
(618) 288-0998
(618) 288-9934
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036099452
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992763353
NPI TYPE I
—
05
—
419662147
—
IL
Enumeration date
12/29/2010
Last updated
12/29/2010
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