NPIMap

Organization Active NPI

George Dermatology, LLC

  • Dermatology Physician
  • Bridgeton, MO
National Provider Identifier
1275046773
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
2006009450 Issued in MO
Legal business name
GEORGE DERMATOLOGY, LLC
Practice address
12255 Depaul Drive
770 North Building
Bridgeton, MO 63044-2515
Phone
(314) 344-0004
Fax
(314) 344-0631
NPI assigned
Nov 7, 2017
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Ms. Mary Noel George, MDNPI 1700998077
Title
Owner
Phone
(314) 344-0004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 2006009450 MO Primary

Addresses

Primary practice location

12255 Depaul Drive
770 North Building
Bridgeton, MO 63044-2515

Mailing address

12255 Depaul Drive
770 North Building
Bridgeton, MO 63044

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1275046773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DEPAUL DRIVE",
            "address_2": "770 NORTH BUILDING",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DEPAUL DRIVE",
            "address_2": "770 NORTH BUILDING",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442515",
            "telephone_number": "314-344-0004",
            "fax_number": "314-344-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-07",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "MARY NOEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-344-0004",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2006009450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.