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General NPI Number Information
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NPI Number | 1992955926
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Entity Type | Organization
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Legal Business Name | KDB ENTERPRISES, INC
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 11630 STUDT AVE
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City | CREVE COEUR
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State | MO
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Zip | 63141-7016
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Country | US
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Telephone | 314-991-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 11630 STUDT AVE
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City | CREVE COEUR
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State | MO
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Zip | 63141-7016
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Country | US
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Telephone | 314-991-2229
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | KENT D BRANSON
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Credential | M.D.
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Telephone | 314-991-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | R8E38
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License Number State | MO
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