Healthcare Provider Details

I. General information

NPI: 1740945484
Provider Name (Legal Business Name): BRENDEN JOHN HERROD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 STATE HIGHWAY 248
BRANSON MO
65616-3725
US

IV. Provider business mailing address

448 STATE HIGHWAY 248
BRANSON MO
65616-3725
US

V. Phone/Fax

Practice location:
  • Phone: 417-337-9808
  • Fax:
Mailing address:
  • Phone: 417-337-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10080341
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025032417
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: