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General NPI Number Information
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NPI Number | 1740307602
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Entity Type | Individual
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Provider Name | BRIAN LOUIS LEBO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 1 BARNES JEWISH HOSPITAL PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-362-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 11108 LEISURE LN
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City | SAINT LOUIS
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State | MO
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Zip | 63146-5309
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Country | US
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Telephone | 314-395-0079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2007038171
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2004025521
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License Number State | MO
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