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General NPI Number Information
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NPI Number | 1669494241
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Entity Type | Individual
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Provider Name | DAVID P DIEMER MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 3015 N NEW BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63131
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Country | US
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Telephone | 314-996-5180
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Fax | 314-821-2180
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Provider Business Mailing Address
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Address Line | 55 WESTPORT PLZ SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3109
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Country | US
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Telephone | 314-548-4772
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Fax | 314-548-4748
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R6G76
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036114605
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License Number State | IL
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