Individual
MR. BRADY THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
121651
LA
163W00000X
Registered Nurse
736869
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
736869
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220429901
—
TX
05
—
220429902
—
TX
01
—
75-0818167-015
TRICARE
TX
01
—
8174UJ
BCBS
TX
01
—
P01408239
RAILROAD MEDICARE
TX
Enumeration date
10/25/2010
Last updated
03/05/2015
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