Provider Demographics
NPI:1295963783
Name:MOORE, BRADLEY J (MD)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:J
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:901 HEARTLAND ROAD, PLAZA 2 SUITE 1800
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-8877
Mailing Address - Fax:816-232-0307
Practice Address - Street 1:901 HEARTLAND ROAD, PLAZA 2 SUITE 1800
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-8877
Practice Address - Fax:816-232-0307
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2014-09-15
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Provider Licenses
StateLicense IDTaxonomies
MO2014009227208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009015677OtherSTATE TEMPORARY LICENCE