Healthcare Provider Details

I. General information

NPI: 1831947183
Provider Name (Legal Business Name): RAYMOND A BRICKHOUSE DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 US HIGHWAY 61
FESTUS MO
63028-4161
US

IV. Provider business mailing address

6400 CLAYTON RD STE 412
SAINT LOUIS MO
63117-1850
US

V. Phone/Fax

Practice location:
  • Phone: 314-381-1800
  • Fax:
Mailing address:
  • Phone: 314-381-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYMOND ANGELO BRICKHOUSE JR.
Title or Position: CEO
Credential: DPM
Phone: 314-381-1800