Provider Demographics
NPI:1497746986
Name:GOSSER, BRIAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:GOSSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 386B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-842-7910
Mailing Address - Fax:314-842-7911
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 386B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-842-7910
Practice Address - Fax:314-842-7911
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209382OtherBLUE CROSS/BLUE SHIELD
MO200858900Medicaid
MOH08266Medicare UPIN
MO200858900Medicaid