Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 014675 | MO |
N | 1223G0001X | General Practice | 014675 | MO |
N | 213EG0000X | General Practice | 014675 | MO |
NPI | 1427221688 |
---|---|
Provider Name | Dr. Duane A Dilworth |
First Address | Saint Louis, MO 63134-2003 |
Second Address | Saint Louis, MO 63134-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 04/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014675 | MO LICENSEE (01) | MO |