Individual
WENDELL D BRONSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
802 N RIVERSIDE RD, SUITE 200, SAINT JOSEPH, MO 64507-2553
(816) 271-7979
(816) 271-7971
Mailing address
802 N RIVERSIDE RD, SUITE 200, SAINT JOSEPH, MO 64507-2553
(816) 271-7979
(816) 271-7971
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
R4J27
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001146000
CHP
MO
05
—
100232910B
—
KS
01
—
19482014
BLUE SHIELD KC
MO
05
—
243710209
—
MO
01
—
4570541
AETNA
MO
Enumeration date
07/03/2006
Last updated
09/18/2017
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