Organization
DELUXE DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUANE ARDIE DILWORTH JR. MD (PHYSICIAN)
(314) 781-0794
Entity
Organization
Contact information
Practice address
1034 S BRENTWOOD BLVD STE 1000, SAINT LOUIS, MO 63117-1210
(314) 781-0794
Mailing address
1034 S BRENTWOOD BLVD STE 1000, SAINT LOUIS, MO 63117-1210
(314) 781-0794
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020010839
MISSOURI BOARD OF REGISTRATION FOR THE HEALING ARTS
MO
Enumeration date
10/03/2020
Last updated
10/03/2020
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