O'Fallon Dermatology Specialists, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

2004004910 Issued in MO

Legal business name

O'FALLON DERMATOLOGY SPECIALISTS, P.C.

Practice address

7136 S Outer Road 364
O Fallon, MO 63368-7756

Phone

(636) 561-3277

Fax

(636) 561-5280

NPI assigned

Feb 28, 2007

Last updated

Mar 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angela J Spray, M.D.NPI 1477599884

Title

Physician

Phone

(636) 561-3277

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela J Spray, M.D.

  • Dermatology Physician
  • O'Fallon, MO
  • NPI 1477599884
  Medicare reassignment Care Compare group NPD Authorized official
• Julie D. Medlin, P.A.-C

  • Medical Physician Assistant
  • O'Fallon, MO
  • NPI 1285729970
  Medicare reassignment Care Compare group
• Casey Wegener, PA-C

  • Physician Assistant
  • O'Fallon, MO
  • NPI 1902293004
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426982400000",
    "number": "1255468906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7136 S OUTER ROAD 364",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687756",
            "telephone_number": "636-561-3277",
            "fax_number": "636-561-5280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7136 S OUTER ROAD 364",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687756",
            "telephone_number": "636-561-3277",
            "fax_number": "636-561-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O'FALLON DERMATOLOGY SPECIALISTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2015-03-22",
        "status": "A",
        "authorized_official_last_name": "SPRAY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "636-561-3277",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "2004004910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nystrom Counseling Mo, PC (Sagent Behavioral Health)
• Rachel O Brien, DC
• John J. O'Brien, M.D.
• John J O'Connor, M.D.
• O'Fallon Dental Partnership, Barry Brace, DMD and Associates, LLC
• O'Fallon Family Dentistry
• O'Fallon Family Eye Care LLC (O'Fallon Family Eyecare)
• O'Fallon Marital & Family Counseling and Wellness Center
• O'Fallon Pain Center
• O'Fallon Pain Relief Associates LLC

• Specialist in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2015; 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.