| Doctor Name: | DR. KURT RUSSELL BRAVATA |
| NPI Number: | 1790096170 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 2013030074 |
| Business Practice Address: | 201 S Ash St Buffalo, MO - 656228674 |
| Business Phone Number: | 4173456100 |
| Business Fax Number: | |
| Mailing Address: | 201 S Ash St, BUFFALO |
| State: | MO |
| Postal Code: | 656228674 |
| Phone Number: | 4173456100 |
| Fax Number: | |
| NPI Enumeration Date: | 06/30/2010 |
| NPI Last Update Date: | 10/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2013030074 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |