Basic Information
| Provider Information | |||||||||
| NPI: | 1306854716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | METZGAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 BROOKS BND | ||||||||
| Address2: | |||||||||
| City: | BROWNSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461128942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178503446 | ||||||||
| FaxNumber: | 8316187002 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 EXECUTIVE DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479054883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654460170 | ||||||||
| FaxNumber: | 7654469279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 06/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01040523 | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000490288 | 01 | IN | ANTHEM | OTHER | 100334990 | 05 | IN | MEDICAID | P00445265 | 01 | IN | RAILROAD | OTHER |