Healthcare Provider Details

I. General information

NPI: 1851319388
Provider Name (Legal Business Name): DARLA MARIE DARBY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S KINGSHIGHWAY
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8111
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4342
  • Fax: 314-747-3813
Mailing address:
  • Phone: 314-362-4342
  • Fax: 314-747-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2004031365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: