Provider Demographics
NPI:1760425995
Name:FOUTS, THOMAS BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRADLEY
Last Name:FOUTS
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 1:10 ROBINSON LN
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-9010
Mailing Address - Country:US
Mailing Address - Phone:406-446-3800
Mailing Address - Fax:406-446-3802
Practice Address - Street 1:10 ROBINSON LN
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9010
Practice Address - Country:US
Practice Address - Phone:406-446-3800
Practice Address - Fax:406-446-3802
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine