Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Brock Davis Ridenour, MD

Individual provider Plastic and Reconstructive Surgery Physician · NPI 1164536710

Dr. Brock Davis Ridenour, MD is a Plastic and Reconstructive Surgery Physician in Saint Louis, Missouri. Practices as a sole proprietor. Licensed in Missouri.

Licensed in
MO
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

12460 Olive Blvd Ste 202
Saint Louis, MO 63141-6409
Phone: (314) 909-1202
Fax: (314) 909-1290
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic and Reconstructive Surgery Physician (primary) Taxonomy 2086S0122X · Licence 101951 (MO)

Record details

NPI number1164536710
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedAugust 19, 2006
Last updated in NPPESJuly 8, 2007

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