Organization
MID-MISSOURI DERMATOLOGISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY EDWARD FOOTE M.D. (PRESIDENT)
(573) 442-3565
Entity
Organization
Contact information
Practice address
1504 E BROADWAY, COLUMBIA, MO 65201-8077
(573) 442-3565
(573) 443-2172
Mailing address
1504 E BROADWAY, COLUMBIA, MO 65201-8077
(573) 442-3565
(573) 443-2172
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
30179
MO
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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