Healthcare Provider Details

I. General information

NPI: 1902034218
Provider Name (Legal Business Name): OZARK MOUNTAIN EAR NOSE & THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 S PAYNE STEWART DR STE 201
BRANSON MO
65616-2732
US

IV. Provider business mailing address

545 BRANSON LANDING BLVD SUITE 410
BRANSON MO
65616-4500
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-3636
  • Fax: 417-335-3626
Mailing address:
  • Phone: 405-209-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2009001424
License Number StateMO

VIII. Authorized Official

Name: DR. JAMES TRAVIS BRAWNER
Title or Position: SOLE MEMBER OF LLC
Credential: M.D.
Phone: 417-230-7874