Provider Demographics
NPI:1659334282
Name:KOFFMAN, BRADLEY H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:H
Last Name:KOFFMAN
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 1:6601 WINCHESTER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4677
Mailing Address - Country:US
Mailing Address - Phone:816-313-2677
Mailing Address - Fax:816-313-6000
Practice Address - Street 1:5721 W 119TH ST
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-498-6270
Practice Address - Fax:913-498-6619
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010186732085R0001X
KS04-293082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2087439201Medicaid
MO205378607Medicaid
KS2087439201Medicaid
KS422B260BMedicare PIN
KS422B260AMedicare PIN