STEPHEN R BRADDOCK (NPI# 1811934490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811934490 |
| Entity Type | Individual |
| Full Name | STEPHEN R BRADDOCK |
| Credential | MD |
| Practice Address |
1465 S Grand Blvd St. Louis MO 63104-1003 |
| Mailing Address |
1465 S Grand Blvd Saint Louis MO 63104-1003 |
| Practice Telephone | 3145775639 |
| Practice Fax Number | 3142684112 |
| Mailing Telephone | 3145775639 |
| Mailing Fax Number | 3142684112 |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-04-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
106085 | MO | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | MD106085 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 207684309 | 05 | |
| VA | 762132 | 05 |
| Street Address |
1465 S GRAND BLVD |
| City | ST. LOUIS |
| State | MO |
| Zip Code | 63104-1003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033115589 | Shulamit Menashe Portnoy | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2005-06-21 |
| 1982959433 | Anya Jennifer Freedman | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2012-07-20 |
| 1508125295 | Neal Russell Hartman | Emergency Medicine | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2012-05-15 |
| 1275820359 | Joseph George Maliakkal | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2011-07-08 |
| 1043500416 | Lauren Rhae Draper | Pediatrics | 1465 S Grand Blvd, Department of Pediatrics Division of Heme/onc, St. Louis, MO 63104 | 2011-04-19 |
| 1043500507 | Debra H Zand | Psychologist | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2011-04-18 |
| 1548569734 | Elisa Rachel Pincus | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2011-03-28 |
| 1265747596 | Dhiren Ranchhodbhai Patel | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2010-08-11 |
| 1346404191 | Justin B Josephsen | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2008-07-10 |
| 1043471477 | Rocio Del Carmen Zeballos-chavez | Internal Medicine | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2008-06-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407469570 | Family Care Health Centers | Clinic/Center | 2717 Sidney Street, St. Louis, MO 63104 | 2020-08-28 |
| 1023638038 | Laura Ann Humphrey | Physician Assistant | Allied Health Building 3437 Caroline Street, Room 3015, Saint Louis, MO 63104 | 2020-04-20 |
| 1174187264 | Ahsan Ali | Student in an Organized Health Care Education/Training Program | 1438 South Grand Blvd, Monteleone Hall, St. Louis, MO 63104 | 2019-04-24 |
| 1205359916 | Brenda Eve Ladin | Behavior Technician | 1221 Allen Market Lane Rear, St. Louis, MO 63104 | 2017-07-25 |
| 1841722063 | Gustavo G Mendez | Student in an Organized Health Care Education/Training Program | 1465 South Grand Bulevard Rm 2717, Ssm Health Cardinal Glennon Children's Hospital, Saint Louis, MO 63104 | 2017-03-28 |
| 1053776716 | Carmella Harper | Respiratory Therapist, Certified | 2678 Park Ave, St Louis, MO 63104 | 2015-12-23 |
| 1922485986 | Alexander Tremont | Internal Medicine | 1402 S Grand Blvd Rm M260, Saint Louis, MO 63104 | 2015-04-29 |
| 1306233341 | Healthcare R Us | Home Health | 2859 Sidney St, St Louis, MO 63104 | 2015-04-16 |
| 1396159091 | Daniela Hermelin | Pathology | 1402 South Grane, St. Louis, MO 63104 | 2014-06-20 |
| 1992117881 | Kelly Denise Durbin | Social Worker | 1920 S 7th St, Saint Louis, MO 63104 | 2014-05-27 |
| Find all providers in zip 63104 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447269444 | Gary S Gottesman | Medical Genetics | 4400 Clayton Ave, Research Center, Saint Louis, MO 63110-1624 | 2006-08-07 |
| 1376569681 | Kimberly A Martin | Medical Genetics | 1705 E Broadway Ste 300, Columbia, MO 65201-7167 | 2006-07-14 |
| 1295180867 | Catherine Gooch | Medical Genetics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2016-05-02 |
| 1780064378 | Katherine Barnes Abell | Medical Genetics | 1 Childrens Pl, Div Ped Cardiology, Saint Louis, MO 63110-1002 | 2015-06-09 |
| 1275910366 | Bonnie Rae Sullivan | Medical Genetics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2015-04-28 |
| 1952717902 | Jorge Luis Granadillo De Luque | Medical Genetics | 1 Childrens Pl, Suite 3s34, Saint Louis, MO 63110-1002 | 2014-07-09 |
| 1386942407 | Ayman W El-hattab | Medical Genetics | 402 N Keene St, Ste 101, Columbia, MO 65201-6986 | 2011-03-14 |
| 1710116207 | Jennifer Michelle Heeley | Medical Genetics | 621 S New Ballas Rd, Suite 281a, Saint Louis, MO 63141-8232 | 2009-07-06 |
| 1700021706 | Shivarajan Manickavasagam Amudhavalli | Medical Genetics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2008-12-05 |
| 1225203672 | Beth Ann Kozel | Medical Genetics | 1 Childrens Pl Ste C, Ste C, Saint Louis, MO 63110-1002 | 2008-04-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.