=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982600284
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA J BRAZIL MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 02/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1235 E CHEROKEE ST ANESTHESIA
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65804-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-820-6863
-----------------------------------------------------
Fax | 417-820-6868
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7868 NW 100TH ST
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34482-7340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-829-4620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 036089061
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | R8E40
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------