Healthcare Provider Details

I. General information

NPI: 1770587057
Provider Name (Legal Business Name): BRADFORD G CARPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 BURKARTH RD
WARRENSBURG MO
64093-3103
US

IV. Provider business mailing address

511 BURKARTH RD
WARRENSBURG MO
64093-3103
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-8154
  • Fax: 660-747-9757
Mailing address:
  • Phone: 660-747-8154
  • Fax: 660-747-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR2E05
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: