Individual
BRANDON D. RIESENMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2001 S CONNOR AVE, JOPLIN, MO 64804-1841
(417) 782-0880
(417) 782-0884
Mailing address
200 E. CENTENNIAL, STE. 13, PITTSBURG, KS 66762
(620) 231-1068
(620) 231-2792
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
04-23189
KS
2084P0800X
Psychiatry Physician
112406
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-23189
KANSAS LICENSE
KS
05
—
208649947
—
MO
05
—
208649962
—
MO
Enumeration date
04/28/2006
Last updated
02/07/2014
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