Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2008016310 | MO |
Y | 208600000X | Surgeon | 2008016310 | MO |
NPI | 1013178326 |
---|---|
Provider Name | Rylan James Brantl |
First Address | Columbia, MO 65212-0001 |
Second Address | Rugby, ND 58368-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 17/03/2018 |