Provider Demographics
NPI:1407815400
Name:BRUSHWOOD, STEVEN D (DO)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:BRUSHWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4954
Mailing Address - Country:US
Mailing Address - Phone:816-232-6818
Mailing Address - Fax:816-232-2991
Practice Address - Street 1:303 S. 169 HWY
Practice Address - Street 2:
Practice Address - City:GOWER
Practice Address - State:MO
Practice Address - Zip Code:64454-0000
Practice Address - Country:US
Practice Address - Phone:816-424-6427
Practice Address - Fax:855-416-3387
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2002008815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208791004Medicaid
KS100288780DMedicaid
KS100288780DMedicaid
231054745OtherDEA
MOH82580Medicare UPIN
MO208791004Medicaid
MO6343060001Medicare NSC
P00193736Medicare ID - Type UnspecifiedRR MEDICARE