MEDICARE: DR. PETER A BRAWER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2009026814	MO

General Provider Information

NPI Number	:	1255319323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A BRAWER PHD

Provider Business Mailing Address
First Line	:	220 W ARGONNE DR STE F
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-4237
Country	:	US
Telephone Number	:	314-413-1794
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 W ARGONNE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-4237
Country	:	US
Telephone Number	:	314-413-1764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	08/13/2012

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