MEDICARE: J THOMAS BROYLES 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	207Q00000X	Family Medicine Physician	35-039714	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902869373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J THOMAS BROYLES MD

Provider Business Mailing Address
First Line	:	3440 RIVERSIDE DR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1743
Country	:	US
Telephone Number	:	614-459-0077
Fax Number	:	614-459-3355

Provider Business Practice Location Address
First Line	:	3440 RIVERSIDE DR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1743
Country	:	US
Telephone Number	:	614-459-0077
Fax Number	:	614-459-3355

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	06/01/2011

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