MEDICARE: BRADLEY JAY THOMPSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	NV4576	NV

General Provider Information

NPI Number	:	1669485306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY JAY THOMPSON MD

Provider Business Mailing Address
First Line	:	3650 S EASTERN AVE
Second Line	:	#300
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-3379
Country	:	US
Telephone Number	:	702-796-8036
Fax Number	:	702-731-5965

Provider Business Practice Location Address
First Line	:	3650 S EASTERN AVE
Second Line	:	#300
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-3379
Country	:	US
Telephone Number	:	702-796-8036
Fax Number	:	702-731-5965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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