Individual
BRYON WESLEY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
303 S MAIN ST, SUITE 212, MISHAWAKA, IN 46544-2189
(574) 254-0800
(574) 254-0812
Mailing address
303 S MAIN ST, SUITE 212, MISHAWAKA, IN 46544-2189
(574) 254-0800
(574) 254-0812
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01052749
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200290600A
—
IN
Enumeration date
06/06/2006
Last updated
08/29/2012
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