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General NPI Number Information
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NPI Number | 1356486179
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Entity Type | Individual
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Provider Name | DERYK L MCDOWELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 625 S NEW BALLAS RD SUITE 2030
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8253
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Country | US
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Telephone | 314-251-1700
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Fax | 314-251-1701
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Provider Business Mailing Address
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Address Line | 136 REAVIS PL
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City | WEBSTER GROVES
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State | MO
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Zip | 63119-4034
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Country | US
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Telephone | 314-961-3498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2005006002
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License Number State | MO
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