Healthcare Provider Details

I. General information

NPI: 1770718579
Provider Name (Legal Business Name): AUSTIN DALRYMPLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-633-7365
  • Fax: 314-268-2712
Mailing address:
  • Phone: 314-633-7365
  • Fax: 314-268-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number2012007497
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: