Healthcare Provider Details

I. General information

NPI: 1780137356
Provider Name (Legal Business Name): RAYMOND A. BRICKHOUSE, DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S JEFFERSON AVE STE 2
SAINT LOUIS MO
63118-3930
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-381-1802
  • Fax: 866-927-4145
Mailing address:
  • Phone: 314-381-1800
  • Fax: 866-927-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2008026233
License Number StateMO

VIII. Authorized Official

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