Organization
ST LOUIS DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY E PETERSEN MD (OWNER)
(314) 200-2713
Entity
Organization
Contact information
Practice address
1011 BOWLES AVENUE, SUITE 121, FENTON, MO 63026-2387
(314) 200-2713
(314) 200-2714
Mailing address
1011 BOWLES AVENUE, SUITE 121, FENTON, MO 63026-2387
(314) 200-2713
(314) 200-2714
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2001020599
MO
Other
Enumeration date
10/14/2013
Last updated
02/18/2014
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