Individual
BRADLEY A PONTANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1905 W 32ND ST, SUITE 103, JOPLIN, MO 64804-1529
(417) 556-2185
Mailing address
1905 W 32ND ST, STE #103, JOPLIN, MO 64804-1529
(417) 556-2185
(417) 556-6968
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G5492
TX
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
G5492
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
G5492
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1230393-03
—
TX
Enumeration date
04/14/2006
Last updated
01/30/2017
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