Healthcare Provider Details

I. General information

NPI: 1982600284
Provider Name (Legal Business Name): MARIA J BRAZIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST ANESTHESIA
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

7868 NW 100TH ST
OCALA FL
34482-7340
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-6863
  • Fax: 417-820-6868
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036089061
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR8E40
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: