Provider Demographics
NPI:1053414227
Name:JOSEPH M DUVALL MD LLC
Entity type:Organization
Organization Name:JOSEPH M DUVALL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-432-5112
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:5002B
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-432-3033
Mailing Address - Fax:314-995-9985
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:5002B
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-432-3033
Practice Address - Fax:314-995-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6127207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013588OtherMEDICARE ID- TYPE UNSPECI
A09737Medicare UPIN