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

Mr. Brian Douglass Bourbon, CERTIFIEDPEDORTHIST

Individual provider Specialist · NPI 1790124923

Mr. Brian Douglass Bourbon, CERTIFIEDPEDORTHIST is a Specialist in Creve Coeur, Missouri. Licensed in Missouri. Registered with an NPI since 2013.

Licensed in
MO
In the registry since
2013

Practice location Address checks out

11709 Old Ballas Rd Ste 201
Creve Coeur, MO 63141-7029
Phone: (314) 432-1903
Fax: (314) 432-5105
Show map & directions

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

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence CPED3999 (MO)

Record details

NPI number1790124923
Entity typeIndividual (Type 1)
GenderMale
Credentials CERTIFIEDPEDORTHIST
Sole proprietorNo
NPI enumeratedJune 20, 2013
Last updated in NPPESJune 20, 2013

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