Basic Information
| Provider Information | |||||||||
| NPI: | 1922118280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUD | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 S GLENSTONE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658023206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178294246 | ||||||||
| FaxNumber: | 4178294332 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 S FREMONT AVE | ||||||||
| Address2: | STE 1000 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658042206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178208099 | ||||||||
| FaxNumber: | 4178208093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 036-066106 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | 24692 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | M-11165 | ID | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 2012003219 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.