Derrick Dufresne

Key facts

NPI

1801548904

Entity type

Individual (NPI type 1)

Primary specialty

Durable Medical Equipment & Medical Supplies 332B00000X

Practice address

12009 Manchester Rd
Des Peres, MO 63131-4416

Phone

(636) 626-9001

NPI assigned

Jan 20, 2022

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 20, 2022.

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1801548904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12009 MANCHESTER RD",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631314416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12009 MANCHESTER RD",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631314416",
            "telephone_number": "636-626-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFRESNE",
        "first_name": "DERRICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Peres, MO

• Des Peres Urgent Care, LLC
• Dierbergs Markets Inc
• Karen Dittmer, NP
• Michael Philip Donahoe, MD
• DRX - FC Management 005, LLC
• Rosalie Marie Duvall, LPC, MT-BC
• Erin Dwyer
• E.X.I Health LLC.
• Cynthia Eaton
• Collin Lane Einertson, D.C.

All providers in Des Peres, MO · Durable Medical Equipment & Medical Supplies in Missouri