1. Home
  2. Directory
  3. Missouri
  4. Creve Coeur
  5. Specialist
  6. NPI Profile

MR. BRIAN DOUGLASS BOURBON CERTIFIED PEDORTHIST
NPI 1790124923
Specialist in Creve Coeur, MO

Active since June 20, 2013
11709 OLD BALLAS RD, SUITE 201, CREVE COEUR, MO 63141(314) 432-1903(314) 432-5105 Get Directions Write a Review

NPPES record last updated: June 20, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mr. Brian Douglass Bourbon Certified Pedorthist NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. BRIAN DOUGLASS BOURBON CERTIFIED PEDORTHIST (NPI 1790124923) is an individual specialist in Creve Coeur, Missouri, licensed in Missouri (CPED3999) and active in the NPI registry since June 2013.

NPPES Registry Identity

NPI1790124923
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameMR. BRIAN DOUGLASS BOURBONCredential: CERTIFIED PEDORTHIST
Location Address11709 OLD BALLAS RD, SUITE 201Creve Coeur, MO 63141-7029
Mailing AddressPo Box 419074Creve Coeur, MO 63141-9074 · (314) 432-1903 · Fax (314) 432-5105
Phone(314) 432-1903
Fax(314) 432-5105
Sole ProprietorNo
Enumeration DateJune 20, 2013
✔ NPI 1790124923 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MO · CPED3999
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
11709 OLD BALLAS RD, Creve Coeur, MO 63141
Open in Google Maps ↗

Other Identifiers 1

OtherCPED3999MO · Certified Pedorthist

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LARRY WILSON THOMAS D.D.S.
Dentist (Pediatric Dentistry)
11709 OLD BALLAS RD, STE 200
CREVE COEUR, MO 63141
St. Louis County (314) 872-8590
DR. JENNIFER A DELANEY MD
Internal Medicine
11709 OLD BALLAS RD
ST LOUIS, MO 63141
St. Louis County (314) 993-1200
DR. THOMAS V OLIVIER MD
Plastic Surgery
11709 OLD BALLAS RD, SUITE 201
CREVE COEUR, MO 63141
St. Louis County (314) 997-8828
CREVE COEUR PERIODONTICS, INC.
Dentist (Periodontics)
11709 OLD BALLAS RD, SUITE 206
CREVE COEUR, MO 63141
St. Louis County (314) 567-3760
DR. JARED VISSER DPM
Podiatrist (Foot & Ankle Surgery)
11709 OLD BALLAS RD, SUITE 201
CREVE COEUR, MO 63141
St. Louis County (314) 432-1903
CYNTHIA WEPPLER MPT
Physical Therapist
11709 OLD BALLAS RD, SUITE 205
SAINT LOUIS, MO 63141
St. Louis County (314) 991-0480
DR. RYAN LEE RADER D.M.D
Dentist
11709 OLD BALLAS RD, SUITE 206
CREVE COEUR, MO 63141
St. Louis County (314) 567-3760
RYAN RADER ENTERPRISES DMD LLC
Dentist (Periodontics)
11709 OLD BALLAS RD, STE 206
CREVE COEUR, MO 63141
St. Louis County (314) 567-3760

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brian Bourbon's NPI number?

The NPI number for Brian Bourbon is 1790124923. It was assigned to this individual provider in the NPPES registry on June 20, 2013.

Where is Brian Bourbon located?

Brian Bourbon practices at 11709 Old Ballas Rd Suite 201, Creve Coeur, MO 63141. The listed phone number is (314) 432-1903.

What is Brian Bourbon's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Brian Bourbon was last updated on June 20, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.