Laser & Dermatologic Surgery Center, Inc.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

R6H14 Issued in MO

Legal business name

LASER & DERMATOLOGIC SURGERY CENTER, INC.

Practice address

1001 Chesterfield Pkwy E
Suite 101
Chesterfield, MO 63017-2041

Phone

(314) 878-3839

Fax

(314) 878-6575

NPI assigned

Feb 27, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Scott Radle, BS HEALTHCARE ADMIN

Title

Practice Manager

Phone

(314) 878-3839

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329091200000",
    "number": "1801862065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CHESTERFIELD PKWY E",
            "address_2": "SUITE 101",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172041",
            "telephone_number": "314-878-3839",
            "fax_number": "314-878-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CHESTERFIELD PKWY E",
            "address_2": "SUITE 101",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172041",
            "telephone_number": "314-878-3839",
            "fax_number": "314-878-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASER & DERMATOLOGIC SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2012-02-13",
        "status": "A",
        "authorized_official_last_name": "RADLE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "314-878-3839",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS HEALTHCARE ADMIN"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MO",
            "license": "R6H14",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rolando A Larice, MD
• Larry E Burrell, DC, LLC
• Antoinette Marie Larson, OTR
• Gabrielle Joann Larson
• Rebecca Lasater, MSW, LCSW
• Tracy Lashbrook, RPH
• Demeshia Laniece Lathon, SLP
• Graham Lauff
• Kim Laux, RNFA
• Lawrence E. Samuels M.D., Inc. (Specialists in Dermatology and Cosmetic medicine)

• MOHS-Micrographic Surgery Physician in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• MOHS-Micrographic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.