1801875919 NPI number — DR. STEVEN D BRAUN MD

Table of content: DR. STEVEN D BRAUN MD (NPI 1801875919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801875919 NPI number — DR. STEVEN D BRAUN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAUN
Provider First Name:
STEVEN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801875919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 505164
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63150-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-820-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 S FREMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65804-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-820-2468
Provider Business Practice Location Address Fax Number:
417-820-7794
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  0422332 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 2011003924 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100127540B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047228 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1801875919 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3251773 001 . This is a "CIGNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 0004134021 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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