Erickson Skin Surgery & Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2006001518 Issued in MO

Legal business name

ERICKSON SKIN SURGERY & DERMATOLOGY, LLC

Practice address

555 N New Ballas Rd
Suite 260
Saint Louis, MO 63141-6825

Phone

(210) 274-5520

NPI assigned

Jan 30, 2012

Organization subpart

No

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

Authorized official

Name

Quenby Lea Erickson, D.O.

Title

Owner

Phone

(210) 274-5520

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1327881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1649542150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N NEW BALLAS RD",
            "address_2": "SUITE 260",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N NEW BALLAS RD",
            "address_2": "SUITE 260",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416825",
            "telephone_number": "210-274-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON SKIN SURGERY & DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-30",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "QUENBY",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-274-5520",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2006001518",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MO",
            "license": "2006001518",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Erhart, P.T.
• Franca Erhiawarie, M.B.,B.S.
• Eric a Nepute DC LLC
• Eric Colton MD PC
• Eric Sincoff LLC
• Anna Spencer Erickson
• Jacob Erickson, MT-BC
• Devin Ericson, MMS, PA-C
• Erika R King, LLC
• Erikalin Ashton, LLC

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; 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.