Provider Demographics
NPI:1770587057
Name:CARPER, BRADFORD G (DO)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:G
Last Name:CARPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2E05207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA112001OtherMEDICARE PTAN #
110031614OtherRAILROAD MEDICARE, PALMETTO
MO242015618Medicaid
MO242015618Medicaid