Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A72166 | CA |
NPI | 1093822363 |
---|---|
Provider Name | Dr. Bradley Macgregor Thomas |
First Address | Manhattan Beach, CA 90266-6814 |
Second Address | Manhattan Beach, CA 90266-6814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 29/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55959 | (02) | CA |
ZZZ02606Z | BLUE SHIELD ZZ NUMBER (01) | CA |