Organization
ADVANCED DERMATOLOGY OF SOUTHEAST MISSOURI PC
Active
Organization
ADVANCED DERMATOLOGY OF SOUTHEAST MISSOURI PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MORRIS MOON MD (PRESIDENT)
(573) 335-7546
Entity
Organization
Contact information
Practice address
2116 MEGAN DR STE 102, CAPE GIRARDEAU, MO 63701-1979
(573) 335-7546
(573) 335-7550
Mailing address
1359 N MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63701-1727
(573) 335-7546
(573) 335-7550
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2007038037
MO
Other
Enumeration date
07/22/2009
Last updated
09/15/2021
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