Healthcare Provider Details

I. General information

NPI: 1427344910
Provider Name (Legal Business Name): JONI RUTH BRAMON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 04/18/2021
Certification Date: 04/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W WORLEY ST
COLUMBIA MO
65203-2037
US

IV. Provider business mailing address

601 W BUSINESS LOOP 70 STE 275
COLUMBIA MO
65203-2522
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-2314
  • Fax: 573-814-2835
Mailing address:
  • Phone: 573-874-0008
  • Fax: 573-875-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS12783
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011017042
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: