Healthcare Provider Details

I. General information

NPI: 1760425995
Provider Name (Legal Business Name): THOMAS BRADLEY FOUTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROBINSON LN
RED LODGE MT
59068-9010
US

IV. Provider business mailing address

10 ROBINSON LN
RED LODGE MT
59068-9010
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-3800
  • Fax: 406-446-3802
Mailing address:
  • Phone: 406-446-3800
  • Fax: 406-446-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9906
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: