Alliance Health & Dermatology

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MDR7D79 Issued in MO

Legal business name

ALLIANCE HEALTH & DERMATOLOGY

Practice address

304 S Mount Auburn Rd
Cape Girardeau, MO 63703-4920

Phone

(573) 803-3331

Fax

(573) 803-2905

NPI assigned

Mar 13, 2007

Last updated

Feb 6, 2020By 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

Mr. Ramiro Icaza, M.D.

Title

Administrator

Phone

(573) 243-2154

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• c/o Ramiro Icaza Other name

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1790818599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S MOUNT AUBURN RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034920",
            "telephone_number": "573-803-3331",
            "fax_number": "573-243-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S MOUNT AUBURN RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034920",
            "telephone_number": "573-803-3331",
            "fax_number": "573-803-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HEALTH & DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "ICAZA",
        "authorized_official_first_name": "RAMIRO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-243-2154",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "MDR7D79",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "593695703",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "alliancedermandhealth@outlook.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "304 S Mount Auburn Rd",
            "city": "Cape Girardeau",
            "state": "MO",
            "country_code": "US",
            "postal_code": "637034920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "c/o Ramiro Icaza",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "c/o Ramiro Icaza",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sajjad Ali
• All Love & Care Home Health
• Darren Michael Allcock, D.O.
• Michelle Lea Allen, FNP-BC
• Scott Allen
• Alliance Health and Dermatology, LLC
• Alliant Medical Services, LLC (AFC Urgent Care)
• Leo Walter Allstun Jr., LPC, CEAP, SAP
• Benjamin J Almand
• Mohammed Alomgir, DO

• Family Medicine Physician in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; 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.