MR. BRIAN BOURBON, CERTIFIED PEDORTHIST

Specialist

Active Individual
NPI: 1790124923

Practice Address

11709 OLD BALLAS RD
SUITE 201
Creve Coeur, MO 63141

Phone: (314) 432-1903

Specialties

Specialty Code Primary License
Specialist 174400000X Yes CPED3999 (MO)

Frequently Asked Questions

NPI 1790124923 is the National Provider Identifier for MR. BRIAN BOURBON, CERTIFIED PEDORTHIST, a Specialist provider located in Creve Coeur, MO. This NPI was enumerated on June 20, 2013.
MR. BRIAN BOURBON, CERTIFIED PEDORTHIST practices at 11709 OLD BALLAS RD, SUITE 201, Creve Coeur, MO 63141.

Quick Facts

NPI
1790124923
Type
Individual
Enumerated
Jun 20, 2013
Last Updated
Jun 20, 2013

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