Provider Demographics
NPI:1255324703
Name:BREER, WAYNE ALAN (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALAN
Last Name:BREER
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 1:1001 CHESTERFIELD PKWY E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2167
Mailing Address - Country:US
Mailing Address - Phone:636-532-2422
Mailing Address - Fax:636-532-2425
Practice Address - Street 1:1001 CHESTERFIELD PKWY E
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2167
Practice Address - Country:US
Practice Address - Phone:636-532-2422
Practice Address - Fax:636-532-2425
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109839207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59602Medicare UPIN
MO002013449Medicare ID - Type Unspecified