Provider Demographics
NPI:1669494241
Name:DIEMER, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:DIEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WESTPORT PLZ
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3109
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:3015 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-996-5180
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6G762085R0202X
IL0361146052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
018013128OtherMO CARE
042012444OtherMO CARE
042012444OtherCARE
1390OtherMO BLUE
300137455OtherRR CARE
4942OtherHCARE USA
P00053301OtherRR CARE
018013128OtherCARE
203719638OtherMO CAID
431725842MIDOtherMERCY
1602178OtherPH PLAN
2781OtherGHP
1390OtherMO BLUE
P00053301OtherRR CARE