St Louis Dermatology LLC
NPI 1760810543 · Dermatology Physician · Fenton, MO
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
St Louis Dermatology LLC is a Dermatology Physician organization in Fenton, MO (NPI 1760810543).
Provider details
- NPI number
- 1760810543
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jeffrey Petersen, Owner(314) 200-2713
- License
- 2001020599 (MO)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2013-10-14
- Last updated
- 2014-02-18
Frequently asked questions
- What is St Louis Dermatology LLC's NPI number?
- St Louis Dermatology LLC's National Provider Identifier (NPI) is 1760810543, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is St Louis Dermatology LLC?
- St Louis Dermatology LLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is St Louis Dermatology LLC located?
- St Louis Dermatology LLC's practice location on file with NPPES is 1011 Bowles Avenue, Fenton, MO 63026-2387.
- What is St Louis Dermatology LLC's phone number?
- The practice phone number listed in the NPPES registry for St Louis Dermatology LLC is (314) 200-2713.
- Does St Louis Dermatology LLC accept Medicare?
- St Louis Dermatology LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for St Louis Dermatology LLC?
- The authorized official listed on St Louis Dermatology LLC's NPPES record is Jeffrey Petersen, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is St Louis Dermatology LLC's NPI active?
- Yes — St Louis Dermatology LLC's NPI (1760810543) is active in the NPPES registry as of the last update on 2014-02-18.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.