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Organization

BRANSON NEPHROLOGY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN R MARTINEZ MD (PRESIDENT)
(417) 334-8288
Entity
Organization

Contact information

Practice address
101 SKAGGS RD, SUITE 302, BRANSON, MO 65616-2075
(417) 334-8288
(417) 334-6966
Mailing address
PO BOX 429, BRANSON, MO 65615-0429
(417) 334-8288
(417) 334-6966

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1154352417
AR
05
1245268051
AR
05
149154002
AR
01
170362
BLUE CROSS MISSOURI
MO
05
506052000
MO
01
CK7038
RAILROAD MEDICARE
MO
Enumeration date
03/01/2006
Last updated
12/23/2010
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