Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. BROCK DAVIS RIDENOUR, MD
Active Sole ProprietorDR. BROCK DAVIS RIDENOUR, MD is a Plastic and Reconstructive Surgery healthcare provider located in SAINT LOUIS, Missouri. NPI 1164536710 is currently active in the NPPES registry. Verify at CMS.
Plastic and Reconstructive Surgery · SAINT LOUIS, MO
Registration Details
- NPI Number
- 1164536710
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 19, 2006 (20.002508305841 yrs)
- Last Updated
- Jul 8, 2007
- License
-
101951 (MO)
- Sole Proprietor
- Yes
Practice Information
- Address
-
12460 OLIVE BLVDSUITE 202SAINT LOUIS, MO, 631416409Browse MO providers · Browse ZIP 63141
- Phone
- 3149091202
- Fax
- 3149091290
- Primary Specialty
-
Plastic and Reconstructive Surgery
2086S0122X
Other Plastic and Reconstructive Surgery Providers in SAINT LOUIS, MO
| Name | Credential | NPI |
|---|---|---|
| DR. CHARLES DAVID ETTELSON | M.D. | 1255332904 |
| JOHN B HOLDS | MD | 1134117732 |
| DR. KAMLESH B PATEL | MD | 1790766186 |
| DR. TERENCE MICHAEL MYCKATYN | MD | 1598781718 |
| DR. KEITH ERIC BRANDT | MD | 1386661916 |
| DR. THOMAS H TUNG | MD | 1851318398 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.