Provider Demographics
NPI:1780945295
Name:HANSON, BRADY (DO)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:HANSON
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 1:3717 S WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6740
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:816-398-6688
Practice Address - Street 1:8800 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-4000
Practice Address - Country:US
Practice Address - Phone:816-321-2200
Practice Address - Fax:816-599-5929
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-38098207Q00000X
MO2015030395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine