Provider Demographics
NPI:1851598353
Name:BRADLEY, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:BRADLEY
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 1:19550 E 39TH ST S STE 410
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2307
Mailing Address - Country:US
Mailing Address - Phone:816-303-2400
Mailing Address - Fax:816-303-2484
Practice Address - Street 1:19550 E 39TH ST S STE 410
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2307
Practice Address - Country:US
Practice Address - Phone:816-303-2400
Practice Address - Fax:816-303-2484
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013009578207XS0106X, 207XS0106X
IN01071129A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM00071661Medicare PIN