IndividualActive
Brian Bourbon, CERTIFIED PEDORTHIST
NPI 1790124923 · Specialist · Creve Coeur, MO
Provider details
- NPI number
- 1790124923
- Entity type
- Individual
- Primary specialty
- SpecialistOther Service Providers
- Credential
- CERTIFIED PEDORTHIST
- Sex
- Male
- Sole proprietor
- No
- License
- CPED3999 (MO)
Specialties & taxonomies
Other Service Providers
Practice location
11709 Old Ballas Rd
Suite 201
Creve Coeur, MO 63141-7029
Phone: (314) 432-1903
Fax: (314) 432-5105
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 419074
Creve Coeur, MO 63141-9074
Registry dates
- Enumerated
- 2013-06-20
- Last updated
- 2013-06-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.