Doctor Name: | JOSE JAVIER DERDOY |
NPI Number: | 1396838876 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 430654872 |
Business Practice Address: | 615 S New Ballas Rd Children's Hospital, Ground Floor, Suite Yg220 Saint Louis, MO - 631418221 |
Business Phone Number: | 3142515550 |
Business Fax Number: | 3142515552 |
Mailing Address: | 615 S New Ballas Rd, Children's Hospital, Ground Floor, Suite Yg220 SAINT LOUIS |
State: | MO |
Postal Code: | 631418221 |
Phone Number: | 3142515550 |
Fax Number: | 3142515552 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 01/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 430654872 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |