Healthcare Provider Details

I. General information

NPI: 1083142913
Provider Name (Legal Business Name): SHAWN BABUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DIV NEUROLOGY ADULT, STE 6C
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8111
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1408
  • Fax: 314-747-8427
Mailing address:
  • Phone: 314-362-4503
  • Fax: 314-362-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA163761
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2021023194
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: