Organization
JOSE J. DERDOY, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE J DERDOY MD (OWNER/PRESIDENT)
(314) 744-9078
Entity
Organization
Contact information
Practice address
845 N NEW BALLAS CT STE 330, CREVE COEUR, MO 63141-7169
(314) 744-9078
Mailing address
845 N NEW BALLAS CT STE 330, CREVE COEUR, MO 63141-7169
(314) 744-9078
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
DONT HAVE SUCH NUMBER
—
Enumeration date
10/25/2018
Last updated
06/11/2019
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