Organization
PHELAN DERMATOLOGY & AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE MARTINEZ (PRACTICE ADMINISTRATOR)
(417) 622-0293
Entity
Organization
Contact information
Practice address
520 E 32ND ST, JOPLIN, MO 64804-3904
(417) 622-0293
(833) 275-1784
Mailing address
520 E 32ND ST, JOPLIN, MO 64804-3904
(417) 622-0293
(833) 275-1784
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
04/15/2021
Last updated
12/24/2024
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