Individual
DOUGLAS L BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17067 S OUTER RD, SUITE 100, BELTON, MO 64012-2165
(816) 331-4000
(816) 331-3626
Mailing address
17067 S OUTER RD, SUITE 100, BELTON, MO 64012-2165
(816) 331-4000
(816) 331-3626
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD R5B55
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100452540A
—
KS
05
—
1689669301
—
MO
05
—
201536331
—
MO
Enumeration date
09/19/2005
Last updated
01/24/2022
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