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

St Louis Dermatology LLC

Organization Dermatology Physician · NPI 1760810543

St Louis Dermatology LLC is a Dermatology Physician in Fenton, Missouri. Licensed in Missouri. Registered with an NPI since 2013.

Licensed in
MO
In the registry since
2013
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1011 Bowles Ave Ste 121
Fenton, MO 63026-2387
Phone: (314) 200-2713
Fax: (314) 200-2714
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 2001020599 (MO)

Record details

NPI number1760810543
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Petersen — Owner · (314) 200-2713
NPI enumeratedOctober 14, 2013
Last updated in NPPESFebruary 18, 2014
Mailing address1011 Bowles Avenue, Suite 121, Fenton, MO 63026-2387

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