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General NPI Number Information
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NPI Number | 1104211085
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Entity Type | Individual
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Provider Name | JOHN BRAINARD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 7450 KESSLER ST STE 105
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-2520
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Country | US
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Telephone | 913-362-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 8901 W 74TH ST STE 10
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-2201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 04-40697
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License Number State | KS
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