Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2015003668 | MO |
NPI | 1063443588 |
---|---|
Provider Name | Dr. Scott C Carrizales |
First Address | Saint Louis, MO 63110-1010 |
Second Address | O Fallon, IL 62269-1962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 02/03/2021 |