Provider Demographics
NPI:1689787459
Name:BRICK, PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BRICK
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 1:605 OLD BALLAS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7000
Mailing Address - Country:US
Mailing Address - Phone:314-872-8740
Mailing Address - Fax:314-432-4348
Practice Address - Street 1:605 OLD BALLAS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7000
Practice Address - Country:US
Practice Address - Phone:314-872-8740
Practice Address - Fax:314-432-4348
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR9N62207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31227OtherBNDD
MOR9N62OtherMEDICAL LICENSE
MOR9N62OtherMEDICAL LICENSE
BB2619863OtherDEA