Individual
BRENT W MIEDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 HOSPITAL DR # 617, COLUMBIA, MO 65201-5275
(573) 814-6346
Mailing address
800 HOSPITAL DR # 617, COLUMBIA, MO 65201-5275
(573) 814-6346
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MDR7N00
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20021458
RR MEDICARE
MO
05
—
203229802
—
MO
Enumeration date
05/15/2006
Last updated
07/19/2012
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