Organization
DERMATOLOGY AT WINGHAVEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RACHEL M QUALLEY M.D. (PHYSICIAN,OWNER)
(636) 561-4613
Entity
Organization
Contact information
Practice address
5551 WINGHAVEN BLVD, STE 210, O FALLON, MO 63368-3617
(636) 561-4613
(636) 561-4610
Mailing address
5551 WINGHAVEN BLVD, STE 210, O FALLON, MO 63368-3617
(636) 561-4613
(636) 561-4610
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2004011011
MO
Other
Enumeration date
11/15/2006
Last updated
08/22/2020
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