Provider Demographics
NPI:1801018536
Name:BRADLEY, JOHN STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEVEN
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-676-2214
Mailing Address - Fax:913-789-3106
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2214
Practice Address - Fax:913-789-3106
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS32784207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00681220OtherRR MEDICARE NUMBER FOR GROUP DC6712
MO1801018536Medicaid
KS200564180AMedicaid
KSP00635002OtherRR MEDICARE GROUP CG8899
40359018OtherBCBS KCMO SMMC EMERGENCY PHYSICIANS GROUP 01674018
40359028OtherBCBS KCMO ER PHYSICIANS SOUTH PA GROUP 30492021
KS200564180BMedicaid
40359028OtherBCBS KCMO ER PHYSICIANS SOUTH PA GROUP 30492021
KS200564180BMedicaid