Brian Bourbon, CERTIFIED PEDORTHIST

NPI 1790124923 · on the registry since 2013

Practice

Address: 11709 Old Ballas Rd
Suite 201
Creve Coeur, MO 63141
Phone: (314) 432-1903
Fax: (314) 432-5105
Organisation at this address: Suburban Foot Care
Core Counseling And Consulting
Creve Coeur Periodontics, Inc.
Ryan Rader Enterprises Dmd Llc
Mid-West Podiatry & Associates, Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 24

Registry record

Primary taxonomy: Specialist
174400000X
Licence states on file: MO
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2013-06-20

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Missouri