Healthcare Provider Details

I. General information

NPI: 1124138367
Provider Name (Legal Business Name): BRIGITTE RENEE CORMIER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/27/2023
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 EAST COMMERCIAL STREET
KAHOKA MO
63445-1701
US

IV. Provider business mailing address

103 EAST COMMERCIAL STREET
KAHOKA MO
63445-1701
US

V. Phone/Fax

Practice location:
  • Phone: 660-727-3377
  • Fax: 660-727-3775
Mailing address:
  • Phone: 660-727-3377
  • Fax: 660-727-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2000146083
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: