=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033205521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY MARK TOWNSEND M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1413 SOUTH SECOND STREET
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-885-7776
-----------------------------------------------------
Fax | 575-205-0346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 393
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64735-0393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-885-7776
-----------------------------------------------------
Fax | 575-205-0346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R8F34
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------