| Dr Brian Joseph Glen, DO | |
|
5301 Veterans Memorial Pkwy, Ste 104, Saint Peters, MO 63376-2298 | |
| (636) 939-3362 | |
| (636) 939-3687 |
| Full Name | Dr Brian Joseph Glen |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 5301 Veterans Memorial Pkwy, Saint Peters, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043779044 | NPI | - | NPPES |
| 200070414 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 2022026389 (Missouri) | Primary |
| Entity Name | Ssm Health Care St Louis |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1275586174 PECOS PAC ID: 7810800737 Enrollment ID: O20031118000393 |
| Entity Name | Ssm Cardinal Glennon Children's Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174577670 PECOS PAC ID: 7012828163 Enrollment ID: O20031231000604 |
| Entity Name | Wuca - Cloverleaf Pediatrics Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1710375928 PECOS PAC ID: 8325350440 Enrollment ID: O20150702000987 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Brian Joseph Glen, DO Po Box 7412025, Chicago, IL 60674-2025 Ph: (636) 939-3362 | Dr Brian Joseph Glen, DO 5301 Veterans Memorial Pkwy, Ste 104, Saint Peters, MO 63376-2298 Ph: (636) 939-3362 |
Dr. Lorena Buffa, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 5301 Veterans Memorial Pkwy, Ste 104, Saint Peters, MO 63376 Phone: 636-939-3362 Fax: 636-939-3687 | |
Dr. Jesse Groh, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 2740 S Saint Peters Pkwy, Suite A, Saint Peters, MO 63303 Phone: 636-441-5437 | |
Larry A Jones, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2730 S Highway 94, Suite 202, Saint Peters, MO 63303 Phone: 636-939-4200 Fax: 636-939-4204 | |
Dr. Joseph A Kahn, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2740 S Highway 94, Suite A, Saint Peters, MO 63303 Phone: 636-441-5437 | |
Dr. Brandon D. Larkin, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 112 Piper Hill Drive, Suite 9, Saint Peters, MO 63376 Phone: 636-441-3444 Fax: 636-441-9832 | |
Dr. Robert J Lobonc, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 4704 Mexico Rd, Saint Peters, MO 63376 Phone: 636-441-4144 Fax: 636-441-4112 |