MEDICARE: DR. ELIZABETH MATTHEWS BRUNT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	R8G02	MO

General Provider Information

NPI Number	:	1275547754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH MATTHEWS BRUNT MD

Provider Business Mailing Address
First Line	:	4253 CLAYTON AVE
Second Line	:	CB 8118
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110
Country	:	US
Telephone Number	:	314-362-5641
Fax Number	:	314-362-0369

Provider Business Practice Location Address
First Line	:	425 S EUCLID AVE
Second Line	:	3RD FLOOR
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1005
Country	:	US
Telephone Number	:	314-362-5641
Fax Number	:	314-362-0369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	10/23/2015

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