Provider Demographics
NPI:1033484175
Name:RAYMOND A. BRICKHOUSE, DPM LLC
Entity Type:Organization
Organization Name:RAYMOND A. BRICKHOUSE, DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:BRICKHOUSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-381-1800
Mailing Address - Street 1:6400 CLAYTON RD STE 412
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1850
Mailing Address - Country:US
Mailing Address - Phone:314-381-1800
Mailing Address - Fax:314-422-7749
Practice Address - Street 1:6400 CLAYTON RD
Practice Address - Street 2:SUITE 412
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1850
Practice Address - Country:US
Practice Address - Phone:314-381-1800
Practice Address - Fax:866-927-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008026233213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1437314812Medicaid
MOMA5750Medicare PIN
ILIL2191Medicare PIN
MOMA5750001Medicare PIN
MO1437314812Medicaid
MO6692370002Medicare NSC
MOMA1359Medicare PIN