DR. PAETRA JANE RUDDY (NPI# 1366738874) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366738874 |
| Entity Type | Individual |
| Full Name | DR. PAETRA JANE RUDDY |
| Credential | MD |
| Practice Address |
522 N New Ballas Rd Ste 316 Saint Louis MO 63141-6857 |
| Mailing Address |
660 S Euclid Ave Cb 8123 Saint Louis MO 63110-1010 |
| Practice Telephone | 3145675873 |
| Practice Fax Number | 3144544323 |
| Mailing Telephone | 3145675873 |
| Mailing Fax Number | 3144544232 |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2019-06-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 2015026116 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ENROLLED | 05 |
| Street Address |
522 N NEW BALLAS RD STE 316 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-6857 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629078985 | Thomas Morgan Hyers | Neuromusculoskeletal Medicine & OMM | 522 N New Ballas Rd, Suite 350, Saint Louis, MO 63141-6857 | 2005-07-28 |
| 1902279953 | Isabel Hartig | Nurse Practitioner | 522 N New Ballas Rd, Suite 240, Saint Louis, MO 63141-6857 | 2015-11-12 |
| 1356727465 | St. Louis Psychiatric Associates, LLC | Specialist | 522 N New Ballas Rd, Suite 245, Saint Louis, MO 63141-6857 | 2015-07-31 |
| 1083968838 | Jamie Lynn Griffith | Nurse Practitioner | 522 N New Ballas Rd, Suite 203, Saint Louis, MO 63141-6857 | 2012-11-01 |
| 1962751115 | Jason B. Amato, Md Dermatology, LLC | Dermatology | 522 N New Ballas Rd, Suite 203, Saint Louis, MO 63141-6857 | 2012-09-04 |
| 1245537778 | Center for Reproductive Medicine and Robotic Surgery, LLC | Obstetrics & Gynecology | 522 N New Ballas Rd, Suite 206, Saint Louis, MO 63141-6857 | 2011-02-18 |
| 1790937654 | Internal Medicine Associates of West County P C | Internal Medicine | 522 N New Ballas Rd, Ste. 371, Saint Louis, MO 63141-6857 | 2008-10-22 |
| 1295996023 | Neighborhood Med Center LLC | Clinic/Center | 522 N New Ballas Rd, Suite 270, Saint Louis, MO 63141-6857 | 2008-06-24 |
| 1528180429 | Ophthalmology West, Inc. | Ophthalmology | 522 N New Ballas Rd, Suite 136, Saint Louis, MO 63141-6857 | 2007-04-04 |
| 1871625491 | Christina M. Quigley | Dentist | 522 N New Ballas Rd, 220, Saint Louis, MO 63141-6857 | 2007-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922605906 | Deluxe Dermatology LLC | Dermatology | 1034 S Brentwood Blvd Ste 1000, Saint Louis, MO 63117-1210 | 2020-10-03 |
| 1417597923 | Anna Marie Aiazzi | Dermatology | 10012 Kennerly Rd Ste 401, Saint Louis, MO 63128-2197 | 2020-01-13 |
| 1821482373 | David Cotter | Dermatology | 9450 Minerva Ave, Saint Louis, MO 63114-3910 | 2015-03-23 |
| 1710320767 | Mallory Shiver Abate | Dermatology | 1755 S Grand Blvd Dept of Dermatology, Saint Louis, MO 63104-1540 | 2013-04-09 |
| 1689935728 | Rebecca Joy Chibnall | Dermatology | 5225 Mid America Plz Ste 2300, Ste 2300, Saint Louis, MO 63129-0002 | 2012-06-05 |
| 1285928697 | Urvi Patel | Dermatology | 522 N New Ballas Rd Ste 316, Ste 316, Saint Louis, MO 63141-6840 | 2011-06-02 |
| 1235428582 | Hala Fatima Adil | Dermatology | 2315 Dougherty Ferry Rd Ste 200b, Slucare Dermatology, Saint Louis, MO 63122-3383 | 2011-04-06 |
| 1376852087 | Michael Slade Stratton | Dermatology | 2325 Dougherty Ferry Rd Ste 201, Saint Louis, MO 63122-3356 | 2010-09-29 |
| 1255643813 | Sarah Alison Finger Basak | Dermatology | 12855 N 40 Dr Ste 180, Saint Louis, MO 63141-8657 | 2010-07-11 |
| 1285835454 | Nita Kohli | Dermatology | 4901 Forest Park Ave Ste 502, Ste 502, Saint Louis, MO 63108-1402 | 2007-05-29 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.