Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | E5212 | AR |
NPI | 1003018748 |
---|---|
Provider Name | Brad A Thomas |
First Address | Little Rock, AR 72205-5412 |
Second Address | Little Rock, AR 72205-5412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 30/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07080011000 | QUALCHOICE (01) | |
165495001 | (05) | AR |