Provider Demographics
NPI:1609878271
Name:GARSTANG, BRADLEY W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:W
Last Name:GARSTANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-781-7730
Mailing Address - Fax:816-415-1886
Practice Address - Street 1:8380 N TULLIS AVE
Practice Address - Street 2:STE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158
Practice Address - Country:US
Practice Address - Phone:816-415-3451
Practice Address - Fax:816-415-3452
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD2001014621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31014041OtherBCBS
MO205805906Medicaid
MOH58935Medicare UPIN