Healthcare Provider Details

I. General information

NPI: 1033212279
Provider Name (Legal Business Name): BRIAN KEVIN KNOWLES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W. LOCKLING ST
BROOKFIELD MO
64628-2336
US

IV. Provider business mailing address

624 W. LOCKLING ST
BROOKFIELD MO
64628-2336
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-3363
  • Fax: 660-258-5409
Mailing address:
  • Phone: 660-258-3363
  • Fax: 660-258-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9F17
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: