Provider Demographics
NPI:1093781775
Name:BARRETT, BRADLEY HUNTER (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:HUNTER
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1636
Mailing Address - Country:US
Mailing Address - Phone:620-325-3055
Mailing Address - Fax:
Practice Address - Street 1:919 MAIN ST
Practice Address - Street 2:ST
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1636
Practice Address - Country:US
Practice Address - Phone:620-325-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100203400AMedicaid
KS618100Medicaid
KSKA3032Medicare PIN
KS100203400AMedicaid
KS010015466Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE