MEDICARE: ROBERT BRADY, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	108492	MO

General Provider Information

NPI Number	:	1235361593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT BRADY, MD, LLC

Provider Business Mailing Address
First Line	:	8301 MARYLAND AVE STE 330
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3660
Country	:	US
Telephone Number	:	314-721-3381
Fax Number	:	314-721-3384

Provider Business Practice Location Address
First Line	:	8301 MARYLAND AVE STE 330
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3660
Country	:	US
Telephone Number	:	314-721-3381
Fax Number	:	314-721-3384

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUSAN ALLMAN
Credential	:
Telephone Number	:	314-721-3381

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	01/09/2024

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