Provider Demographics
NPI:1578671418
Name:BRYAN, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:111 SAINT LUKES CENTER DR STE 40
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:131-443-4343
Mailing Address - Fax:314-434-1277
Practice Address - Street 1:111 SAINT LUKES CENTER DR STE 40
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-434-3434
Practice Address - Fax:314-743-1336
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036155656208800000X
MO2004006659208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208361105Medicaid
MO208361105Medicaid
MO920150816Medicare PIN