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General NPI Number Information
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NPI Number | 1063741767
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Entity Type | Organization
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Legal Business Name | BRYAN WARNER MD PC
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD SUITE 516
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1223
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Country | US
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Telephone | 877-445-9050
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Fax | 877-445-9051
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Provider Business Mailing Address
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Address Line | 1034 S BRENTWOOD BLVD SUITE 516
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1223
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Country | US
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Telephone | 877-445-9050
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Fax | 877-445-9051
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRYAN WARNER
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Credential | M.D.
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Telephone | 877-445-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2009032163
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License Number State | MO
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