Individual
DR. BRENDAN MANUEL FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12855 N 40 DR STE 125, SAINT LOUIS, MO 63141-8663
(314) 806-1770
Mailing address
12855 N 40 DR STE 375, SAINT LOUIS, MO 63141-8657
(314) 806-1770
(314) 362-2107
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
036158187
IL
207T00000X
Neurological Surgery Physician
Primary
2013020671
MO
Other
Enumeration date
07/01/2013
Last updated
10/10/2023
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