Provider Demographics
NPI:1558494807
Name:VINCE, BRADLEY DUNCAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DUNCAN
Last Name:VINCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14553 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-9807
Mailing Address - Country:US
Mailing Address - Phone:913-696-1601
Mailing Address - Fax:913-696-1640
Practice Address - Street 1:10103 METCALF AVE.
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:913-696-1601
Practice Address - Fax:913-696-1640
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-285021744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study