Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | R2P77 | MO |
Y | 2086S0122X | Plastic and Reconstructive Surgery | R2P77 | MO |
N | 2086S0127X | Trauma Surgeon | R2P77 | MO |
NPI | 1386661916 |
---|---|
Provider Name | Dr. Keith Eric Brandt |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203002605 | (05) | MO |