26D2069553 CLIA NUMBER - MISSOURI DERMATOLOGY LASER & VEIN CENTER

Laboratory Demographics

  • CLIA Code: 26D2069553
  • Facility Name: MISSOURI DERMATOLOGY LASER & VEIN CENTER
  • Facility Address: 1011 BOWLES, SUITE 121
    FENTON, MO
    ZIP 63026
  • Facility Phone: 314 200-2713
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JEFFREY PETERSEN
  • NPI Number: 1669494357
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2069553
LAB Type Physician Office
Facility Name MISSOURI DERMATOLOGY LASER & VEIN CENTER
Street 1011 BOWLES, SUITE 121
City FENTON
State MO
ZIP 63026
Phone 314 200-2713
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Physician Office
Lab Director JEFFREY PETERSEN

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This page was last updated on: 9/29/2025