Bourbon, Brian Douglass

Bourbon, Brian Douglass is an individual health care provider with primary practice located at 11709 Old Ballas Rd Suite 201, Creve Coeur MO 63141-7029. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Bourbon, Brian Douglass can be contacted via phone (314) 432-1903.

Contact Information

Primary practice address
11709 Old Ballas Rd Suite 201 Creve Coeur MO 63141-7029
Phone: (314) 432-1903
Fax: (314) 432-5105
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X CPED3999 Missouri

Profile Details

NPI number 1790124923
LBN Legal business name Bourbon, Brian Douglass
Credentials CERTIFIED PEDORTHIST
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2013
Last updated Jun 20th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790124923 NPPES
Missouri Other CPED3999 CERTIFIED PEDORTHIST

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