Braddock, Stephen R
Braddock, Stephen R is an sole proprietor health care provider with primary practice located at 1465 S Grand Blvd , St. Louis MO 63104-1003. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.). Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) is his primary health care specialty. Braddock, Stephen R can be contacted via phone (314) 577-5639.Contact Information
Primary practice address
1465 S Grand Blvd
St. Louis MO 63104-1003
Phone: (314) 577-5639
Fax: (314) 268-4112
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | MD106085 | Missouri |
| Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) | 207SG0201X | 106085 | Missouri |
Profile Details
| NPI number | 1811934490 |
|---|---|
| LBN Legal business name | Braddock, Stephen R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 1st, 2006 |
| Last updated | Jan 15th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811934490 | NPPES |
| Virginia | MEDICAID | 762132 | |
| Virginia | MEDICAID | 207684309 |
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