Individual
DR. BRIAN NUSSENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4921 PARKVIEW PL, STE 11A, SAINT LOUIS, MO 63110-1032
(314) 362-7509
(314) 747-9744
Mailing address
660 S EUCLID AVE, C B 8115, SAINT LOUIS, MO 63110-1010
(314) 362-7509
(314) 747-5593
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2002009369
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208731505
—
MO
Enumeration date
07/14/2006
Last updated
11/14/2016
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