Individual provider · Type 1 NPI

Brian Douglass Bourbon, CERTIFIED PEDORTHIST

Specialist · Creve Coeur, MO

NPI number 1790124923 Active

Practice location

11709 Old Ballas Rd, Suite 201
Creve Coeur, MO 63141-7029

Call (314) 432-1903 Map

Fax (314) 432-5105

Mailing address

PO Box 419074
Creve Coeur, MO 63141-9074

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000XCPED3999 (MO)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1790124923

Brian Douglass Bourbon, CERTIFIED PEDORTHIST's National Provider Identifier is 1790124923, issued on Jun 20, 2013. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Creve Coeur, MO. The record was last updated on Jun 20, 2013.