Provider Demographics
NPI:1003918665
Name:KILBRIDGE, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:KILBRIDGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:C B 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2479
Mailing Address - Fax:314-454-2524
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2479
Practice Address - Fax:314-454-2524
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2009-07-20
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Provider Licenses
StateLicense IDTaxonomies
MO2006022621208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208352609Medicaid
MO208352609Medicaid
MO208352609Medicaid