Stephen R Braddock
Pediatrician Clinical Genetics (M.D.)
1465 S Grand Blvd
StLouis
, Missouri 63104-1003
Stephen R Braddock
Pediatrician Clinical Genetics (M.D.)
1465 S Grand Blvd
StLouis
, Missouri 63104-1003
(314) 268-4112
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About
Features
Specialties
- Clinical Genetics (M.D.)
- Pediatrician
Languages spoken
- English
Location
First Address
- Stephen R Braddock
- 1465 S Grand Blvd
- Saint Louis, MO
- Zip : 63104-1003
- Fax : (314) 268-4112
- Phone : (314) 577-5639
Second Address
- Stephen R Braddock
- 1465 S Grand Blvd
- St. Louis, MO
- Zip : 63104-1003
- Fax : (314) 268-4112
- Phone : (314) 577-5639
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207SG0201X | Clinical Genetics (M.D.) | 106085 | MO |
| N | 208000000X | Pediatrician | MD106085 | MO |
National Provider Identifier
| NPI | 1811934490 |
|---|---|
| Provider Name | Stephen R Braddock |
| First Address | Saint Louis, MO 63104-1003 |
| Second Address | St. Louis, MO 63104-1003 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/06/2006 |
| Last Update Date | 15/01/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 207684309 | (05) | MO |
| 762132 | (05) | VA |
| F11231 | (02) | MO |
| F11231 | (02) | VA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.