Provider Demographics
NPI:1154322618
Name:TOMS, JEREMY BRIAN
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:BRIAN
Last Name:TOMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BLANKENBAKER PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1895
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 BLANKENBAKER PKWY STE 301
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1895
Practice Address - Country:US
Practice Address - Phone:800-928-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90623207L00000X
WAMD00044648207L00000X
AZ48426207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00254895OtherRAILROAD MEDICARE
WAI37474Medicare UPIN
OR027968Medicaid
WA1122274Medicaid
WAG8855038Medicare PIN