Healthcare Provider Details

I. General information

NPI: 1255422192
Provider Name (Legal Business Name): BRUCE E THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5957 FASHION POINT DR SUITE 101
OGDEN UT
84403-5180
US

IV. Provider business mailing address

1055 N 500 W
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5683
  • Fax: 801-475-9499
Mailing address:
  • Phone: 801-375-8858
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number5181983-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5181983-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: