Dermatology Center, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MO2001027199 Issued in MO

Legal business name

DERMATOLOGY CENTER, LLC

Practice address

10101 Stoltz Dr
Rolla, MO 65401-7714

Phone

(573) 364-0122

Fax

(573) 364-0129

NPI assigned

Dec 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joseph M Malters, MDNPI 1689760233

Title

Owner

Phone

(573) 364-0122

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph M Malters, M.D.

  • Dermatology Physician
  • Rolla, MO
  • NPI 1689760233
  Medicare reassignment NPD Authorized official
• William V Stoecker, M.D.

  • Dermatology Physician
  • Rolla, MO
  • NPI 1104919851
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557532800000",
    "number": "1154486827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 STOLTZ DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654017714",
            "telephone_number": "573-364-0122",
            "fax_number": "573-364-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 STOLTZ DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654017714",
            "telephone_number": "573-364-0122",
            "fax_number": "573-364-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-23",
        "last_updated": "2019-05-11",
        "status": "A",
        "authorized_official_last_name": "MALTERS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-364-0122",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MO",
            "license": "MO2001027199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506121300",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Decher, LCSW
• Angela Delaria, CRNA
• Ryan Eugene Denney, D.O
• Dental Professionals of Missouri, Richard Straus, D.M.D., P.C.
• Heather R. Derix, PSY.D.
• Alec Deveney, AU.D.
• Cynthia G. Dicus, FNP
• Collin Dobson, CRNA
• Elizabeth C Dodd, D.O.
• Marek Domanski, MD

• Dermatology Physician in Rolla, MO
• Providers in Rolla, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.