Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Advanced Dermatology of Southeast Missouri PC

Organization Dermatology Physician · NPI 1770713950

Advanced Dermatology of Southeast Missouri PC is a Dermatology Physician 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
Show map & directions

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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