Organization
BRANSON PULMONOLOGY LLC
Active
Other names
Tri Lakes Pulmonology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED BAKRY M.D. (PHYSICIAN)
(417) 230-8070
Entity
Organization
Contact information
Practice address
545 BRANSON LANDING BLVD STE 301, BRANSON, MO 65616-4055
(417) 230-8070
(417) 336-1280
Mailing address
545 BRANSON LANDING BLVD STE 301, BRANSON, MO 65616-4055
(417) 230-8070
(417) 336-1280
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
2005015440
MO
207RP1001X
Pulmonary Disease Physician
Primary
2005015440
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015456
MEDICARE PTAN
MO
05
—
507601300
—
MO
Enumeration date
09/05/2007
Last updated
05/29/2008
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