Provider Demographics
NPI:1962695452
Name:DUESENBERG, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DUESENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:714 SPIRIT 40 PARK DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1146
Mailing Address - Country:US
Mailing Address - Phone:636-536-9776
Mailing Address - Fax:636-536-0984
Practice Address - Street 1:714 SPIRIT 40 PARK DR
Practice Address - Street 2:SUITE 145
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1146
Practice Address - Country:US
Practice Address - Phone:636-536-9776
Practice Address - Fax:636-536-0984
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1103272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry