Individual
JONATHAN D. DEHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1034 S BRENTWOOD BLVD, STE 280, SAINT LOUIS, MO 63117-1223
(314) 727-0012
(314) 727-0014
Mailing address
2344 HAMPTON AVE, SAINT LOUIS, MO 63139-2909
(314) 647-2344
(314) 647-5108
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R5411
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1600006
MEDICARE COMPLETE
MO
01
—
194361
BLUE CROSS BLUE SHIELD
MO
01
—
27716
GROUP HEALTH PLAN
MO
01
—
3848
CMR
MO
Enumeration date
07/17/2006
Last updated
07/08/2007
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