OrganizationActive
Advanced Dermatology of Southeast Missouri PC
NPI 1770713950 · Dermatology Physician · Cape Girardeau, MO
Provider details
- NPI number
- 1770713950
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Charles Moon, President(573) 335-7546
- License
- 2007038037 (MO)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(85/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 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
2116 Megan Dr Ste 102
Cape Girardeau, MO 63701-1979
Phone: (573) 335-7546
Fax: (573) 335-7550
Street-level locationGet directions
Mailing address
1359 N Mount Auburn Rd
Cape Girardeau, MO 63701-1727
Registry dates
- Enumerated
- 2009-07-22
- Last updated
- 2021-09-15
- Certified
- 2021-09-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.