Healthcare Provider Details

I. General information

NPI: 1912109760
Provider Name (Legal Business Name): JOEL O BRENDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST.
ST. JOSEPH MO
64506-3488
US

IV. Provider business mailing address

5325 FARAON ST.
ST. JOSEPH MO
64506-3488
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-7273
  • Fax: 816-271-7376
Mailing address:
  • Phone: 816-271-7273
  • Fax: 816-271-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29002
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number299002
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2007008846
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: