Provider Demographics
NPI:1699712323
Name:BROWN, BRUCE E (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10777 SUNSET OFFICE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1019
Mailing Address - Country:US
Mailing Address - Phone:314-822-5900
Mailing Address - Fax:314-822-5919
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-925-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164357208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO129054OtherBLUE CHOICE
MO437904OtherHEALTHLINK
MO129054OtherBLUE SHIELD
MO1700357OtherUNITED HEALTHCARE
MO205157316Medicaid
MO020047080Medicare PIN
MO437904OtherHEALTHLINK
MO1700357OtherUNITED HEALTHCARE
A02429Medicare UPIN
MOP00415529Medicare PIN