Provider Demographics
NPI:1477637148
Name:WOODS, BRADLEY KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:KEITH
Last Name:WOODS
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 1:823 SW MULVANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1764
Mailing Address - Country:US
Mailing Address - Phone:785-354-9591
Mailing Address - Fax:785-368-0739
Practice Address - Street 1:823 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1764
Practice Address - Country:US
Practice Address - Phone:785-354-9591
Practice Address - Fax:785-368-0739
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33182208600000X
LA024675208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002013OtherMEDICARE PTAN
KS200558410AMedicaid