Provider Demographics
NPI:1790759256
Name:MCBRIDE, MEGAN C (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 HORAN DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2408
Mailing Address - Country:US
Mailing Address - Phone:636-349-7191
Mailing Address - Fax:636-349-9063
Practice Address - Street 1:832 HORAN DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2408
Practice Address - Country:US
Practice Address - Phone:636-349-7191
Practice Address - Fax:636-349-9063
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003009200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14497Medicare UPIN