Organization
ERICKSON SKIN SURGERY & DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QUENBY LEA ERICKSON D.O. (OWNER)
(210) 274-5520
Entity
Organization
Contact information
Practice address
555 N NEW BALLAS RD, SUITE 260, SAINT LOUIS, MO 63141-6825
(210) 274-5520
Mailing address
555 N NEW BALLAS RD, SUITE 260, SAINT LOUIS, MO 63141-6825
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2006001518
MO
207ND0101X
MOHS-Micrographic Surgery Physician
2006001518
MO
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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