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General NPI Number Information
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NPI Number | 1154322618
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Entity Type | Individual
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Provider Name | JEREMY BRIAN TOMS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | 400 BLANKENBAKER PKWY STE 301
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City | LOUISVILLE
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State | KY
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Zip | 40243-1895
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Country | US
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Telephone | 800-928-9036
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Fax |
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Provider Business Mailing Address
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Address Line | 400 BLANKENBAKER PKWY STE 301
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City | LOUISVILLE
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State | KY
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Zip | 40243-1895
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A90623
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD00044648
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License Number State | WA
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