Individual
DR. BRENDON DELPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2828 N NATIONAL AVE, SPRINGFIELD, MO 65803-4306
(417) 837-4003
(417) 875-4782
Mailing address
2828 N NATIONAL AVE, SPRINGFIELD, MO 65803-4306
(417) 837-4003
(417) 875-4782
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2004008249
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194721100
—
MO
05
—
209165604
—
MO
01
—
P00261949
RR MEDICARE
—
Enumeration date
06/23/2005
Last updated
06/16/2011
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