Derdoy, Jose Javier

Derdoy, Jose Javier is an individual health care provider with primary practice located at 615 S New Ballas Rd Children'S Hospital, Ground Floor, Suite Yg220, Saint Louis MO 63141-8221. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Pediatric Gastroenterology. Allopathic & Osteopathic Physicians / Pediatric Gastroenterology is his primary health care specialty. Derdoy, Jose Javier can be contacted via phone (314) 251-5550.

Contact Information

Primary practice address
615 S New Ballas Rd Children'S Hospital, Ground Floor, Suite Yg220 Saint Louis MO 63141-8221
Phone: (314) 251-5550
Fax: (314) 251-5552
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 430654872 Missouri
Allopathic & Osteopathic Physicians / Pediatric Gastroenterology 2080P0206X 2007002166 Missouri

Profile Details

NPI number 1396838876
LBN Legal business name Derdoy, Jose Javier
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2006
Last updated Jan 8th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396838876 NPPES
California MEDICAID 00A730200
California MEDICAID 1396838876

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