Basic Information
| Provider Information | |||||||||
| NPI: | 1407815400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUSHWOOD | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2303 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645064954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162326818 | ||||||||
| FaxNumber: | 8162322991 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 S. 169 HWY | ||||||||
| Address2: | |||||||||
| City: | GOWER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644540000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164246427 | ||||||||
| FaxNumber: | 8554163387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2002008815 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 208791004 | 05 | MO | MEDICAID | 231054745 | 01 | DEA | OTHER | 100288780D | 05 | KS | MEDICAID |