Provider Demographics
NPI:1265693766
Name:BRADFORD G CARPER SR DO PC
Entity type:Organization
Organization Name:BRADFORD G CARPER SR DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARPER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:660-747-8154
Mailing Address - Street 1:511 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3103
Mailing Address - Country:US
Mailing Address - Phone:660-747-8154
Mailing Address - Fax:660-747-9757
Practice Address - Street 1:511 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3103
Practice Address - Country:US
Practice Address - Phone:660-747-8154
Practice Address - Fax:660-747-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2E05207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1120OtherMEDICARE PTAN #
MO242015618Medicaid
MODN5221OtherRAILROAD MEDICARE
D16868Medicare UPIN