Provider Demographics
NPI:1396767349
Name:BRIZENDINE, SONAL PATEL (MD)
Entity type:Individual
Prefix:DR
First Name:SONAL
Middle Name:PATEL
Last Name:BRIZENDINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY, BUILDING A
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-7800
Mailing Address - Fax:660-886-3328
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY, BUILDING A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7800
Practice Address - Fax:660-831-3328
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008034612207Q00000X
SCTL25410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC25-25410OtherSC CONTROLLED SUBSTANCES
SCTL25410OtherSTATE LICENSE
SCBB8543995OtherFED DEA NUMBER
SCTL25410OtherSTATE LICENSE