Individual
DR. BRADLEY D. CONNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1075 NICHOLS RD, OSAGE BEACH, MO 65065-3093
(573) 302-3111
(573) 302-2869
Mailing address
1075 NICHOLS RD, OSAGE BEACH, MO 65065-3093
(573) 302-3111
(573) 302-2869
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
0424419
KS
208800000X
Urology Physician
Primary
102732
MO
208800000X
Urology Physician
26727
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100153430B
—
KS
01
—
340017670
RAILROAD MEDICARE
—
Enumeration date
02/22/2006
Last updated
10/12/2016
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