Healthcare Provider Details

I. General information

NPI: 1023472511
Provider Name (Legal Business Name): JOSHUA BRANDON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

PO BOX 9007
SPRINGFIELD MO
65808-9007
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3800
  • Fax:
Mailing address:
  • Phone: 417-875-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2020033532
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: