Healthcare Provider Details

I. General information

NPI: 1003447376
Provider Name (Legal Business Name): BRANDON L BRESSLER PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 BRISTOL RD
WALNUT SHADE MO
65771-9187
US

IV. Provider business mailing address

567 BRISTOL RD
WALNUT SHADE MO
65771-9187
US

V. Phone/Fax

Practice location:
  • Phone: 417-559-1682
  • Fax:
Mailing address:
  • Phone: 417-559-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: