St Louis University

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

ST LOUIS UNIVERSITY

Doing business as

Slucare Dept of Dermatology-Mohs Surgery

Practice address

1225 South Grand, 2L, Door 3,4,5
St Louis, MO 63104

Phone

(314) 977-3400

NPI assigned

May 3, 2007

Last updated

Sep 21, 2021By 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

Alyce Lanxon

Title

Executive Director

Phone

(314) 977-6828

Specialties & licenses 1

Addresses

Other names 1

• SLUCARE DEPT OF DERMATOLOGY-MOHS SURGERY Doing business as

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1962624585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 LINDELL BLVD FL 3",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031020",
            "telephone_number": "314-977-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 SOUTH GRAND, 2L, DOOR 3,4,5",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63104",
            "telephone_number": "314-977-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1755 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041540",
            "country_code": "US",
            "telephone_number": "314-256-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST LOUIS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "LANXON",
        "authorized_official_first_name": "ALYCE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-977-6828"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLUCARE DEPT OF DERMATOLOGY-MOHS SURGERY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SLUCARE DEPT OF DERMATOLOGY-MOHS SURGERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• MOHS-Micrographic Surgery Physician in Saint Louis, MO
• Providers in Saint Louis, 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 Sep 21, 2021; 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.