Individual
DR. KURT RUSSELL BRAVATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 S ASH ST, BUFFALO, MO 65622-8674
(417) 345-6100
(417) 345-6866
Mailing address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3011
(417) 328-6501
(417) 328-6338
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2013030074
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01259379
PALMETTO GBA RAILROAD
MO
Enumeration date
06/30/2010
Last updated
12/29/2016
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