Jose J. Derdoy, MD, LLC

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

Legal business name

JOSE J. DERDOY, MD, LLC

Practice address

845 N New Ballas CT Ste 330
Creve Coeur, MO 63141-7169

Phone

(314) 744-9078

NPI assigned

Oct 25, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jose J Derdoy, MD

Title

Owner/President

Phone

(314) 744-9078

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1003383258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N NEW BALLAS CT STE 330",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417169",
            "telephone_number": "314-744-9078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N NEW BALLAS CT STE 330",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417169",
            "telephone_number": "314-744-9078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSE J. DERDOY, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-25",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "DERDOY",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "314-744-9078",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DONT HAVE SUCH NUMBER",
            "identifier": "000000000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Gastroenterology Physician in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Pediatric Gastroenterology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.