Provider Demographics
NPI:1740945484
Name:HERROD, BRENDEN JOHN (MD)
Entity type:Individual
Prefix:
First Name:BRENDEN
Middle Name:JOHN
Last Name:HERROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 STATE HIGHWAY 248
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3725
Mailing Address - Country:US
Mailing Address - Phone:417-337-9808
Mailing Address - Fax:
Practice Address - Street 1:448 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3725
Practice Address - Country:US
Practice Address - Phone:417-337-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10080341207Q00000X
MO2025032417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine