Provider Demographics
NPI:1992955926
Name:KDB ENTERPRISES, INC
Entity type:Organization
Organization Name:KDB ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-991-2229
Mailing Address - Street 1:11630 STUDT AVE
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7016
Mailing Address - Country:US
Mailing Address - Phone:314-991-2229
Mailing Address - Fax:
Practice Address - Street 1:11630 STUDT AVE
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7016
Practice Address - Country:US
Practice Address - Phone:314-991-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8E38207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE12115Medicare UPIN