Healthcare Provider Details

I. General information

NPI: 1780432229
Provider Name (Legal Business Name): RAYMOND A. BRICKHOUSE DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 INDUSTRIAL DR
FESTUS MO
63028-4133
US

IV. Provider business mailing address

1479 US HIGHWAY 61 STE B
FESTUS MO
63028-4162
US

V. Phone/Fax

Practice location:
  • Phone: 314-381-1800
  • Fax: 314-442-7749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND ANGELO BRICKHOUSE
Title or Position: OWNER
Credential: DPM
Phone: 314-381-1800