Organization
ALLIANCE HEALTH & DERMATOLOGY
Active
Other names
c/o Ramiro Icaza
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAMIRO ICAZA M.D. (ADMINISTRATOR)
(573) 243-2154
Entity
Organization
Contact information
Practice address
304 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4920
(573) 803-3331
(573) 803-2905
Mailing address
304 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4920
(573) 803-3331
(573) 243-3400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MDR7D79
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
593695703
—
MO
Enumeration date
03/13/2007
Last updated
02/06/2020
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