Provider Demographics
NPI:1558335638
Name:BRADSHAW, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 PIPER HILL DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1651
Mailing Address - Country:US
Mailing Address - Phone:636-928-5950
Mailing Address - Fax:636-928-5952
Practice Address - Street 1:107 PIPER HILL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1651
Practice Address - Country:US
Practice Address - Phone:636-928-5950
Practice Address - Fax:636-928-5952
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR2C09208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH30464Medicare UPIN