Individual
BRADY CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2525 GLENN HENDREN DR, LIBERTY, MO 64068-9625
(816) 781-7200
(816) 792-7196
Mailing address
PO BOX 804408, KANSAS CITY, MO 64180-4408
(913) 647-4100
(913) 647-4120
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
2015033276
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57687015
BCBS KC
MO
05
—
910026513
—
MO
01
—
P02049871
RAILROAD
MO
Enumeration date
09/18/2015
Last updated
12/10/2020
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