Dr. Jacob Dudzinski
Dermatologist
615 S New Ballas Rd
Saint Louis
, Missouri 63141-8221
Dr. Jacob Dudzinski
Dermatologist
615 S New Ballas Rd
Saint Louis
, Missouri 63141-8221
(708) 263-8523
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Dr. Jacob Dudzinski
- 3612 Manhattan Ave
- Saint Louis, MO
- Zip : 63143-4117
- Phone : (708) 263-8523
Second Address
- Dr. Jacob Dudzinski
- 615 S New Ballas Rd
- Saint Louis, MO
- Zip : 63141-8221
- Phone : (314) 509-5305
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 2021024175 | MO |
National Provider Identifier
| NPI | 1033788872 |
|---|---|
| Provider Name | Dr. Jacob Dudzinski |
| First Address | Saint Louis, MO 63143-4117 |
| Second Address | Saint Louis, MO 63141-8221 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/06/2021 |
| Last Update Date | 24/06/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.