Bradley D. Connett, M.D.
Individual provider Active NPI Urology Physician · Osage Beach, MO
NPI 1750356663 · NPPES record last updated Oct 12, 2016
Key facts
- NPI
- 1750356663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Urology Physician 208800000X
- License
- 102732 (MO)
- Practice address
- 1075 Nichols Rd
Osage Beach, MO 65065-3093 - Phone
- (573) 302-3111
- Fax
- (573) 302-2869
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0424419 | KS | MD | Urology Physician |
| 26727 | KY | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-America Urology, PA | Urology | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 102732 | MO | Yes |
| Urology Physician | 208800000X | 0424419 | KS | |
| Urology Physician | 208800000X | 26727 | KY |
Addresses
Primary practice location
1075 Nichols Rd
Osage Beach, MO 65065-3093
Mailing address
1075 Nichols Rd
Osage Beach, MO 65065-3093
Phone (573) 302-3111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 340017670 | Other | RAILROAD MEDICARE | |
| 100153430B | Medicaid | KS |
Other providers in Osage Beach, MO
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- Kayla Dawn Collins
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- Jasha B Conner
- Laura Davis
- Kim Ann Dempsey
- John D Despain
- Thomas A Dettmer
- James D Dexter
All providers in Osage Beach, MO · Urology Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.