Individual
STACY BEATY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1755 S GRAND, ST LOUIS, MO 63104
(314) 256-3433
(314) 256-3431
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-6828
(314) 977-6777
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2005004429
MO
Other
Enumeration date
07/16/2006
Last updated
07/08/2007
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