Healthcare Provider Details

I. General information

NPI: 1376946210
Provider Name (Legal Business Name): BRETT A TAYLOR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 WOODS MILL RD STE 201
BALLWIN MO
63011-3657
US

IV. Provider business mailing address

884 WOODS MILL RD STE 201
BALLWIN MO
63011-3657
US

V. Phone/Fax

Practice location:
  • Phone: 636-227-8226
  • Fax:
Mailing address:
  • Phone: 636-227-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JERRIE K WEITH
Title or Position: BUSINESS ADVISOR
Credential:
Phone: 314-655-5558