Provider Demographics
NPI:1982635207
Name:PALMER, BRADLEY J (DO)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:PALMER
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 1:7840 W 165TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3021
Mailing Address - Country:US
Mailing Address - Phone:913-373-2141
Mailing Address - Fax:913-373-2146
Practice Address - Street 1:7840 W 165TH ST STE 160
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3021
Practice Address - Country:US
Practice Address - Phone:913-373-2141
Practice Address - Fax:913-373-2146
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0525765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS14000230OtherMEDICARE
KS100236180DMedicaid