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General NPI Number Information
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NPI Number | 1982804704
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Entity Type | Individual
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Provider Name | TEIDE BRISIBE EHIMARE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 11325 SAINT CHARLES ROCK RD
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City | BRIDGETON
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State | MO
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Zip | 63044-2722
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Country | US
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Telephone | 636-825-2200
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Fax | 636-825-2201
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Provider Business Mailing Address
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Address Line | 1 JEFFERSON BARRACKS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63125-4181
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2012003220
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License Number State | MO
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