Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Advanced Dermatology of Southeast Missouri PC

Organization Dermatology Physician · NPI 1770713950

Advanced Dermatology of Southeast Missouri PC provides Dermatology Physician services in Cape Girardeau, Missouri. Licensed in Missouri. Registered with an NPI since 2009.

Licensed in
MO
In the registry since
2009
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2116 Megan Dr Ste 102
Cape Girardeau, MO 63701-1979
Phone: (573) 335-7546
Fax: (573) 335-7550
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 2007038037 (MO)

Record details

NPI number1770713950
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Charles Moon — President · (573) 335-7546
NPI enumeratedJuly 22, 2009
Last updated in NPPESSeptember 15, 2021
Certification dateSeptember 10, 2021
Mailing address1359 N Mount Auburn Rd, Cape Girardeau, MO 63701-1727

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