Provider Demographics
NPI:1306854716
Name:THOMAS, BRUCE METZGAR (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:METZGAR
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BROOKS BND
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8942
Mailing Address - Country:US
Mailing Address - Phone:317-850-3446
Mailing Address - Fax:831-618-7002
Practice Address - Street 1:114 EXECUTIVE DR
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4883
Practice Address - Country:US
Practice Address - Phone:765-446-0170
Practice Address - Fax:765-446-9279
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040523207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000490288OtherANTHEM
IN100334990Medicaid
INP00445265OtherRAILROAD
IN804640SSMedicare PIN
IN100334990Medicaid
IN000000490288OtherANTHEM
INP00445265Medicare PIN