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Organization
BRANSON NEPHROLOGY LLC
Active
Organization
BRANSON NEPHROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R MARTINEZ MD (PRESIDENT)
(417) 334-8288
Entity
Organization
Contact information
Practice address
101 SKAGGS RD, SUITE 302, BRANSON, MO 65616-2075
(417) 334-8288
(417) 334-6966
Mailing address
PO BOX 429, BRANSON, MO 65615-0429
(417) 334-8288
(417) 334-6966
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154352417
—
AR
05
—
1245268051
—
AR
05
—
149154002
—
AR
01
—
170362
BLUE CROSS MISSOURI
MO
05
—
506052000
—
MO
01
—
CK7038
RAILROAD MEDICARE
MO
Enumeration date
03/01/2006
Last updated
12/23/2010
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