Healthcare Provider Details

I. General information

NPI: 1740337542
Provider Name (Legal Business Name): BRADLEY P THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 NORMANDIE DR STE 110
MONTGOMERY AL
36111-2732
US

IV. Provider business mailing address

2055 NORMANDIE DR STE 110
MONTGOMERY AL
36111-2732
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-4624
  • Fax: 334-280-3628
Mailing address:
  • Phone: 343-288-4624
  • Fax: 343-280-3628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD26715
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD26715
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD26715
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: