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Mr. Brian Douglass Bourbon, CERTIFIEDPEDORTHIST
Specialist in Creve Coeur, Missouri
NPI 1790124923

Brian Douglass Bourbon is a Specialist based in Creve Coeur, MO. Brian Douglass Bourbon practices in Creve Coeur, MO and has the professional credentials of CERTIFIEDPEDORTHIST. The NPI Number for Brian Douglass Bourbon is 1790124923 and holds a License No. CPED3999 (Missouri).

The current practice location address for Brian Douglass Bourbon is 11709 Old Ballas Rd, Creve Coeur, MO and can be reached out via phone at 314-432-1903 and via fax at 314-432-5105.

Location: 11709 Old Ballas Rd, Creve Coeur, MO, 63141-9074
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790124923
Provider Name
Brian Douglass Bourbon
Credential
CERTIFIEDPEDORTHIST
Provider Entity Type
Individual
Gender
Male
Address
11709 Old Ballas Rd, Creve Coeur, MO, 63141-9074
Phone Number
314-432-1903
Fax Number
314-432-5105
Provider Enumeration Date
06/20/2013
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
CPED3999 01 MO CERTIFIED PEDORTHIST
institution
Provider Business Practice Location Address Details
Address
11709 Old Ballas Rd
City
Creve Coeur
State
Missouri
Zip
63141-7029
Phone Number
314-432-1903
Fax Number
314-432-5105
person
Provider Business Mailing Address Details
Address
11709 Old Ballas Rd
City
Creve Coeur
State
Missouri
Zip
63141-7029
Phone Number
314-432-1903
Fax Number
314-432-5105
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
CPED3999 (Missouri)
Definition
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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