DELUXE DERMATOLOGY LLC


Address: 1034 S Brentwood Blvd Ste 1000, Saint Louis, MO 63117-1210
Phone: 3147810794

DELUXE DERMATOLOGY LLC (NPI# 1922605906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1922605906
Entity Type Organization
Organization Name DELUXE DERMATOLOGY LLC
Practice Address 1034 S Brentwood Blvd Ste 1000
Saint Louis
MO 63117-1210
Practice Telephone 3147810794
Mailing Telephone 3147810794
Enumeration Date 2020-10-03
Last Update Date 2020-10-03
Authorized Official Name DR. DUANE ARDIE DILWORTH JR. (PHYSICIAN)
Authorized Official Telephone 3147810794
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
MO MISSOURI BOARD OF REGISTRATION FOR THE HEALING ARTS 2020010839 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
11125 Dunn Rd Ste 411, Saint Louis, MO 631366132 3143557111 3143558604

Office Location

Street Address 1034 S BRENTWOOD BLVD STE 1000
City SAINT LOUIS
State MO
Zip Code 63117-1210

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NPI Name Taxonomy Address Enumeration
1255956611 Efehi Kelly Ogbomo Student in an Organized Health Care Education/Training Program 6420 Clayton Rd, Suite 2218, St. Louis, MO 63117 2020-06-11
1619533890 Abdul Rauf Student in an Organized Health Care Education/Training Program 6420 Clayton Road. Ssm Health St. Mary's Hospital, St. Louis, MO 63117 2019-05-14
1083278477 Mohamed Maali Gumaa Mohamed Student in an Organized Health Care Education/Training Program 6420 Clayton Road Ssm St. Mary's Hospital, Department of Internal Medicine, St. Louis, MO 63117 2019-05-01
1750945556 Samrat Jun Jayanth Student in an Organized Health Care Education/Training Program 6420 Clayton Road, Ssm Health St Mary's Hospital, St. Louis, MO 63117 2019-04-26
1215491329 Latonya Allen Counselor 1612 S. Big Bend Blvd, St. Louis, MO 63117 2019-01-23
1265917025 Blue Stars Therapy, LLC Occupational Therapist 1101 Edward Terrace, Apt A, St. Louis, MO 63117 2018-09-27
1770060014 Ultra Care Home Services LLC Home Health 7353 Dale Ave, Saint Louis, MO 63117 2018-07-19
1235623562 Melissa Valerie Taylor Counselor Psychological Services of St Louis, LLC, 7110 Oakland Ave, St Louis, MO 63117 2018-06-20
1124517289 Jideofor Ebony Obodozie Student in an Organized Health Care Education/Training Program 6420 Clayton Road, Ssm St. Mary's Hospital, St. Louis, MO 63117 2018-05-04
1770071706 Sivaram Prabhuji Muppaneni Student in an Organized Health Care Education/Training Program Ssm St Mary's Hospital, 6420 Clayton Road, St. Louis, MO 63117 2018-04-25
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Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1417597923 Anna Marie Aiazzi Dermatology 10012 Kennerly Rd Ste 401, Saint Louis, MO 63128-2197 2020-01-13
1821482373 David Cotter Dermatology 9450 Minerva Ave, Saint Louis, MO 63114-3910 2015-03-23
1710320767 Mallory Shiver Abate Dermatology 1755 S Grand Blvd Dept of Dermatology, Saint Louis, MO 63104-1540 2013-04-09
1689935728 Rebecca Joy Chibnall Dermatology 5225 Mid America Plz Ste 2300, Ste 2300, Saint Louis, MO 63129-0002 2012-06-05
1285928697 Urvi Patel Dermatology 522 N New Ballas Rd Ste 316, Ste 316, Saint Louis, MO 63141-6840 2011-06-02
1235428582 Hala Fatima Adil Dermatology 2315 Dougherty Ferry Rd Ste 200b, Slucare Dermatology, Saint Louis, MO 63122-3383 2011-04-06
1376852087 Michael Slade Stratton Dermatology 2325 Dougherty Ferry Rd Ste 201, Saint Louis, MO 63122-3356 2010-09-29
1255643813 Sarah Alison Finger Basak Dermatology 12855 N 40 Dr Ste 180, Saint Louis, MO 63141-8657 2010-07-11
1285835454 Nita Kohli Dermatology 4901 Forest Park Ave Ste 502, Ste 502, Saint Louis, MO 63108-1402 2007-05-29
1346372109 Mark Udey Dermatology 4921 Parkview Pl Ste 5a, Ste 5a, Saint Louis, MO 63110-1032 2007-03-09
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City SAINT LOUIS
Zip Code 63117

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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