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General NPI Number Information
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NPI Number | 1023137957
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Entity Type | Organization
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Legal Business Name | SKB LLC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 514 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-2730
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Country | US
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Telephone | 636-441-3322
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Fax | 636-441-4302
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Provider Business Mailing Address
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Address Line | 514 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-2730
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Country | US
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Telephone | 636-441-3322
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Fax | 636-441-4302
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Authorized Official
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Title or Position | OWNER,PHYSICIAN
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Name | DR. SHAWN K BRUNK
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Credential | D.O.
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Telephone | 636-441-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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