Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 2007018713 | MO |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2007018713 | MO |
NPI | 1134319858 |
---|---|
Provider Name | Dr. Brian Robert Kriete |
First Address | Rolla, MO 65401-2905 |
Second Address | Rolla, MO 65401-8022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 27/05/2021 |