Individual
DR. BRADLEY TERRILL THACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 CHILDRENS PL, SAINT LOUIS, MO 63110-1002
(314) 454-6148
(314) 454-4633
Mailing address
1 CHILDRENS PL, C B 8116, SAINT LOUIS, MO 63110-1002
(314) 454-6148
(314) 454-4633
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
R7332
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195010381
—
MO
Enumeration date
07/17/2006
Last updated
11/21/2012
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