Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2019020171 | MO |
N | 207N00000X | Dermatologist | 35074 | OK |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2019020171 | MO |
N | 207ND0101X | MOHS-Micrographic Surgeon | 35074 | OK |
NPI | 1376852087 |
---|---|
Provider Name | Dr. Michael Slade Stratton |
First Address | Saint Louis, MO 63122-3356 |
Second Address | Saint Louis, MO 63122-3356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2010 |
Last Update Date | 15/04/2020 |