1699714121

Everything you always wanted to know about BRANDSTED M REBECCA MD but were afraid to ask.

BRANDSTED M REBECCA MD

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Provider Last Name Provider Middle Name Provider First Name Provider Credential
BRANDSTED M REBECCA MD
Gender:
Female
Enumeration date:
2006-06-06
Last update date:
2011-05-19
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
Yes
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Identifiers

identifier description issuer state
2004000617 Other MO LICENSE NUMBER MO
888635229 Other DEA NUMER MO

Taxonomies

Taxonomy State License Number Primary?
207Y00000X Otolaryngology MO 2004000617 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 3147290077
Mailing Address Fax Number 3147290101
Practice Location Address Telephone Number 3149659184
Practice Location Address Fax Number 3149848019

Addresses

Type Address City State Postal Country
Mailing Address PO BOX 790379 STE 405 SAINT LOUIS MO 63179 MO
Practice Location Address 1011 BOWLES AVE FENTON MO 63026 MO

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