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General NPI Number Information
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NPI Number | 1568417772
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Entity Type | Individual
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Provider Name | BRETT L THORSTAD M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 3024 BUSINESS PARK CIR
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-3132
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Country | US
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Telephone | 615-851-6033
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Fax | 615-851-2018
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Provider Business Mailing Address
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Address Line | 3024 BUSINESS PARK CIR
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-3132
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Country | US
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Telephone | 615-851-6033
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Fax | 615-851-2018
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD25159
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 25159
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 25159
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License Number State | TN
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