Healthcare Provider Details

I. General information

NPI: 1578671418
Provider Name (Legal Business Name): DAVID E BRYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MCKELVEY RD STE 102
BRIDGETON MO
63044-2550
US

IV. Provider business mailing address

PO BOX 14369
SAINT LOUIS MO
63178-4369
US

V. Phone/Fax

Practice location:
  • Phone: 314-408-3244
  • Fax:
Mailing address:
  • Phone: 314-567-6071
  • Fax: 314-453-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2004006659
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036155656
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: