Provider Demographics
NPI:1265720395
Name:DUNBAR, BRADEN (DO)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NE VIVION RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-6127
Mailing Address - Country:US
Mailing Address - Phone:816-453-1314
Mailing Address - Fax:816-453-3434
Practice Address - Street 1:2000 NE VIVION RD
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-6127
Practice Address - Country:US
Practice Address - Phone:816-453-1314
Practice Address - Fax:816-453-3434
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019408207Q00000X
MO218279362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1265720395Medicaid
MO1265720395Medicaid