Basic Information
| Provider Information | |||||||||
| NPI: | 1851598353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19550 E 39TH ST S STE 410 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163032400 | ||||||||
| FaxNumber: | 8163032484 | ||||||||
| Practice Location | |||||||||
| Address1: | 19550 E 39TH ST S STE 410 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163032400 | ||||||||
| FaxNumber: | 8163032484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 2013009578 | MO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.