Provider Demographics
NPI:1669485306
Name:THOMPSON, BRADLEY JAY (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAY
Last Name:THOMPSON
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 1:3650 S EASTERN AVE
Mailing Address - Street 2:#300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-3379
Mailing Address - Country:US
Mailing Address - Phone:702-796-8036
Mailing Address - Fax:702-731-5965
Practice Address - Street 1:3650 S EASTERN AVE
Practice Address - Street 2:#300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-3379
Practice Address - Country:US
Practice Address - Phone:702-796-8036
Practice Address - Fax:702-731-5965
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV4576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C96638Medicare UPIN
NVV0000BCBBJMedicare ID - Type Unspecified