Organization
ST LOUIS KIDNEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK SLOAN LARSON MD (OWNER)
(314) 548-0265
Entity
Organization
Contact information
Practice address
456 N NEW BALLAS RD STE 348, CREVE COEUR, MO 63141-6846
(314) 548-0265
(314) 548-6555
Mailing address
PO BOX 78429, SAINT LOUIS, MO 63178-8429
(314) 548-0265
(314) 548-6555
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500014637
—
MO
Enumeration date
06/18/2014
Last updated
09/30/2025
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