MEDICARE: DR. BRADLEY W GARSTANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD2001014621	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31014041	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1609878271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY W GARSTANG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 219672
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64121-9672
Country	:	US
Telephone Number	:	816-781-7730
Fax Number	:	816-415-1886

Provider Business Practice Location Address
First Line	:	8380 N TULLIS AVE
Second Line	:	STE 300
City	:	KANSAS CITY
State	:	MO
Zip	:	64158
Country	:	US
Telephone Number	:	816-415-3451
Fax Number	:	816-415-3452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/05/2018

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