Individual
JOSE JAVIER DERDOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 S NEW BALLAS RD, CHILDREN'S HOSPITAL, GROUND FLOOR, SUITE YG220, SAINT LOUIS, MO 63141-8221
(314) 251-5550
(314) 251-5552
Mailing address
615 S NEW BALLAS RD, CHILDREN'S HOSPITAL, GROUND FLOOR, SUITE YG220, SAINT LOUIS, MO 63141-8221
(314) 251-5550
(314) 251-5552
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
430654872
MO
2080P0206X
Pediatric Gastroenterology Physician
Primary
2007002166
MO
2080P0206X
Pediatric Gastroenterology Physician
60035
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A730200
—
CA
05
—
1396838876
—
MO
05
—
300096168
—
IN
Enumeration date
10/02/2006
Last updated
10/04/2024
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