MR. Brian Douglass Bourbon, CERTIFIED PEDORTHIST
NPI #1790124923 in Creve Coeur, Missouri
Provider Information
- NPI Number
- 1790124923
- Entity Type
- Individual
- Name
- MR. Brian Douglass Bourbon, CERTIFIED PEDORTHIST
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Specialist
- Credential
- CERTIFIED PEDORTHIST
- Enumeration Date
- Jun 20, 2013
- Last Updated
- Jun 20, 2013
Practice Location
- Address
- 11709 OLD BALLAS RD
- Address 2
- SUITE 201
- City
- Creve Coeur
- State
- Missouri
- ZIP Code
- 63141-7029
- Phone
- (314) 432-1903
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist |
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