Organization
DALE F. DIERBERG, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE F DIERBERG MD (PRESIDENT)
(636) 227-6839
Entity
Organization
Contact information
Practice address
509 WEST 18TH STREET, DEPT. OF RADIOLOGY, HERMANN, MO 65041
(573) 486-2191
Mailing address
2753 AUTUMN RUN CT, CHESTERFIELD, MO 63005-7030
(636) 227-6839
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10108
HELATHCARE USA
MO
01
—
3079111
CIGNA
MO
01
—
784
BCBS
MO
01
—
8076
GROUP HEALTH PLAN
MO
05
—
NO ID UNDER INDIVIDU
—
MO
Enumeration date
09/08/2006
Last updated
10/09/2007
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