Provider Demographics
NPI:1699714121
Name:BRANDSTED, REBECCA M (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:BRANDSTED
Suffix:
Gender:
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:PO BOX 14369
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-4369
Mailing Address - Country:US
Mailing Address - Phone:314-729-0077
Mailing Address - Fax:314-729-0101
Practice Address - Street 1:1001 S KIRKWOOD RD STE 320
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7254
Practice Address - Country:US
Practice Address - Phone:314-965-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004000617207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004000617OtherMO LICENSE NUMBER
MO888635229OtherDEA NUMER
MO2004000617OtherMO LICENSE NUMBER
MOI56717Medicare UPIN