Individual
MR. BRANDON M UFERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0449
Mailing address
1239 E MAIN ST, CARBONDALE, IL 62901-3175
(618) 549-0721
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2012007845
MO
163W00000X
Registered Nurse
RN184161
AZ
367500000X
Certified Registered Nurse Anesthetist
Primary
209022763
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MULTISPECIALTY GROUP PTAN
IL
Enumeration date
04/29/2020
Last updated
09/28/2021
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