Provider Demographics
NPI:1255422192
Name:THOMAS, BRUCE E (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
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 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-375-8858
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:5957 FASHION POINT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5180
Practice Address - Country:US
Practice Address - Phone:801-475-5683
Practice Address - Fax:801-475-9499
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5181983-1205207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT200302299OtherTAX ID
UT005750502Medicare ID - Type Unspecified
UT200302299OtherTAX ID