Provider Demographics
NPI:1003018748
Name:THOMAS, BRAD A (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAINT VINCENT CIR STE 502
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5412
Mailing Address - Country:US
Mailing Address - Phone:501-558-0200
Mailing Address - Fax:501-558-0201
Practice Address - Street 1:5 SAINT VINCENT CIR STE 502
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5412
Practice Address - Country:US
Practice Address - Phone:501-558-0200
Practice Address - Fax:501-558-0201
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5212207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
07080011000OtherQUALCHOICE
AR165495001Medicaid
5N935Medicare PIN