Provider Demographics
NPI:1477556520
Name:BREDEMAN, THOMAS K (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:BREDEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 PEMBROKE SQ
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5731
Mailing Address - Country:US
Mailing Address - Phone:573-690-5665
Mailing Address - Fax:
Practice Address - Street 1:3205 PEMBROKE SQ
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5731
Practice Address - Country:US
Practice Address - Phone:573-690-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO246894406Medicaid
MO32232OtherBNDD
MO32232OtherBNDD
MOF63765Medicare UPIN