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General NPI Number Information
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NPI Number | 1922605906
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Entity Type | Organization
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Legal Business Name | DELUXE DERMATOLOGY LLC
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Dates
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Enumeration Date | 10/03/2020
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Last Update Date | 10/03/2020
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD STE 1000
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1210
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Country | US
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Telephone | 314-781-0794
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 S BRENTWOOD BLVD STE 1000
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1210
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Country | US
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Telephone | 314-781-0794
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DUANE ARDIE DILWORTH JR.
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Credential | MD
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Telephone | 314-781-0794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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