Individual provider · Type 1 NPI
Brock Davis Ridenour, MD
Plastic and Reconstructive Surgery Physician · St. Louis, MO
NPI number
1164536710
Active
Practice location
12460 Olive Blvd, Suite 202
St. Louis, MO 63141-6409
Fax (314) 909-1290
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Plastic and Reconstructive Surgery Physician Primary | 2086S0122X | 101951 (MO) |
Plastic and Reconstructive Surgery Physician: A surgeon who specializes in plastic and reconstructive surgery.
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About NPI 1164536710
Brock Davis Ridenour, MD's National Provider Identifier is 1164536710, issued on Aug 19, 2006. The primary taxonomy on file is Plastic and Reconstructive Surgery Physician (2086S0122X), and the practice location is in St. Louis, MO. The record was last updated on Jul 8, 2007.