Organization
FIRST CAPITOL DERMATOLOGY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY W. CLEVER III MD (PHYSICIAN/OWNER)
(636) 916-1300
Entity
Organization
Contact information
Practice address
901 S. 5TH ST., FIRST CAPITOL DERMATOLOGY, L.L.C., ST. CHARLES, MO 63301-2416
(636) 916-1300
(636) 916-1561
Mailing address
901 S. 5TH ST., FIRST CAPITOL DERMATOLOGY, L.L.C., ST. CHARLES, MO 63301-2416
(636) 916-1300
(636) 916-1561
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
R4P68
MO
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
R4P68
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203348628
—
MO
Enumeration date
04/03/2008
Last updated
03/01/2017
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