Provider Demographics
NPI:1104933720
Name:THOMAS, BRADLEY GLYNN (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GLYNN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:022-534-9245
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:4003 KRESGE WAY STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-897-5139
Practice Address - Fax:502-896-6218
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY427242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01062396AOtherSTATE LICENSE
KY42724OtherSTATE LICENSE
IN01062396AOtherSTATE LICENSE