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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