MR. BRIAN DOUGLASS BOURBON (NPI# 1790124923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790124923 |
| Entity Type | Individual |
| Full Name | MR. BRIAN DOUGLASS BOURBON |
| Credential | CERTIFIED PEDORTHIST |
| Practice Address |
11709 Old Ballas Rd Suite 201 Creve Coeur MO 63141-7029 |
| Mailing Address |
Po Box 419074 Creve Coeur MO 63141-9074 |
| Practice Telephone | 3144321903 |
| Practice Fax Number | 3144325105 |
| Mailing Telephone | 3144321903 |
| Mailing Fax Number | 3144325105 |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2013-06-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | CPED3999 | MO | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | CERTIFIED PEDORTHIST | CPED3999 | 01 |
| Street Address |
11709 OLD BALLAS RD SUITE 201 |
| City | CREVE COEUR |
| State | MO |
| Zip Code | 63141-7029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720512551 | Brittany Ryan Staples | Podiatrist | 11709 Old Ballas Rd, Ste 201, Creve Coeur, MO 63141-7029 | 2017-04-18 |
| 1952754772 | Sameera Riaz-malik | Social Worker | 11709 Old Ballas Rd, Suite 205, Creve Coeur, MO 63141-7029 | 2016-07-16 |
| 1255759197 | Ryan Rader Enterprises Dmd LLC | Dentist | 11709 Old Ballas Rd, Ste 206, Creve Coeur, MO 63141-7029 | 2014-03-28 |
| 1174812358 | Jared Visser | Podiatrist | 11709 Old Ballas Rd, Suite 201, Creve Coeur, MO 63141-7029 | 2011-03-29 |
| 1366697906 | Shirley Mae Catoire Visser | Podiatrist | 11709 Old Ballas Rd, Suite 201, Creve Coeur, MO 63141-7029 | 2008-11-24 |
| 1174799415 | Creve Coeur Periodontics, Inc. | Dentist | 11709 Old Ballas Rd, Suite 206, Creve Coeur, MO 63141-7029 | 2008-05-06 |
| 1760697965 | Douglas John Fox | Dentist | 11709 Old Ballas Rd, Creve Coeur, MO 63141-7029 | 2007-05-11 |
| 1295956167 | Milton A Rubin | Psychologist | 11709 Old Ballas Rd, Suite 105, Creve Coeur, MO 63141 | 2007-05-01 |
| 1245451749 | Ryan Lee Rader | Dentist | 11709 Old Ballas Rd, Suite 206, Creve Coeur, MO 63141-7029 | 2007-05-01 |
| 1609906577 | Mid-west Podiatry and Associates, LLC | Podiatrist | 11709 Old Ballas Rd, Suite 201, Creve Coeur, MO 63141-7029 | 2007-03-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | 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. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346399102 | Carlos A. Maitz M.d. | Specialist | 680 Craig Road, Suite 303, Creve Coeur, MO 63141-7144 | 2007-01-10 |
| 1043318116 | Norma M Swanson | Specialist | 12755 Olive Blvd, Suite 115, Creve Coeur, MO 63141-6242 | 2006-09-20 |
| 1720094295 | Holly H. Kodner | Specialist | 10806 Olive Blvd, Creve Coeur, MO 63141-7773 | 2006-08-01 |
| 1922260132 | Midwest Hemorrhoid Treatment Center Town & Country LLC | Specialist | 450 N New Ballas Rd, Suite 266, Creve Coeur, MO 63141-6835 | 2008-06-29 |
| 1568504009 | Barbara Sue Baer | Specialist | 641 N New Ballas Rd, Creve Coeur, MO 63141-6713 | 2007-02-13 |
| 1760524516 | Balanced Care for Women of St Louis, PC | Specialist | 10806 Olive Blvd, Creve Coeur, MO 63141-7773 | 2007-02-12 |
| 1356357867 | Kathy C. Maupin | Specialist | 10806 Olive Blvd, Creve Coeur, MO 63141-7773 | 2006-08-01 |
| 1700892221 | Laura A. Baalmann | Specialist | 10806 Olive Blvd, Creve Coeur, MO 63141-7773 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497381990 | Styles 40 Salon | Specialist | 4550 Gravois Ave, Saint Louis, MO 63116-2426 | 2020-03-16 |
| 1013560721 | Against The Grainz | Specialist | 8523 Drury Ln, Saint Louis, MO 63147-1313 | 2019-07-22 |
| 1487211033 | Kia Lanay Lewis | Specialist | 9700 Portage Dr, Saint Louis, MO 63136-5312 | 2019-05-20 |
| 1659935815 | Nicole Pittman | Specialist | 3004 Chance Dr, Florissant, MO 63031-1436 | 2019-04-23 |
| 1376011007 | Lashonda S Wash | Specialist | 222 Bruce Ave, Saint Louis, MO 63135-2704 | 2018-11-12 |
| 1326516048 | Showna Walker | Specialist | 2242 Berwyn Dr, Saint Louis, MO 63136-5415 | 2018-11-12 |
| 1306326061 | Sleek Barber & Beauty Salon | Specialist | 13220 New Halls Ferry Rd, Florissant, MO 63033-3231 | 2018-08-21 |
| 1760973697 | Angela Haas | Specialist | 1361 Childress Ave, Saint Louis, MO 63139-3451 | 2018-05-26 |
| 1164913497 | Gina Marie Savage | Specialist | 2400 Troost Ave Ste 3400, Kansas City, MO 64108-2666 | 2018-05-22 |
| 1962907782 | Kelsey Conley | Specialist | 2839 Howard St, Saint Louis, MO 63106-2027 | 2018-03-25 |
| Find all providers with the same taxonomy | ||||
| City | CREVE COEUR |
| Zip Code | 63141 |
Please comment or provide details below to improve the information on MR. BRIAN DOUGLASS BOURBON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.