Individual
DR. BROCK DAVIS RIDENOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12460 OLIVE BLVD, SUITE 202, SAINT LOUIS, MO 63141-6409
(314) 909-1202
(314) 909-1290
Mailing address
12460 OLIVE BLVD, SUITE 202, SAINT LOUIS, MO 63141-6409
(314) 909-1202
(314) 909-1290
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
101951
MO
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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