Individual
DR. BRADLEY JOHN VIVACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65212-1702
(573) 882-4141
Mailing address
1115 W BROADWAY APT E, COLUMBIA, MO 65203-2100
(317) 441-0437
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2021018962
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2018
Last updated
06/25/2021
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