Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2005015827 | MO |
N | 2080P0208X | Pediatric Infectious Diseases | 2005015827 | MO |
N | 2080P0216X | Pediatric Rheumatologist | 2005015827 | MO |
NPI | 1679759617 |
---|---|
Provider Name | Bradley Ornstein |
First Address | Saint Louis, MO 63141 |
Second Address | Saint Louis, MO 63141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2008 |
Last Update Date | 11/10/2019 |