Thomas K Bredeman, D.O.
Individual provider Active NPI Specialist · Jefferson City, MO
NPI 1477556520 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1477556520
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 36582 (MO)
- Practice address
- 3205 Pembroke SQ
Jefferson City, MO 65109-5731 - Phone
- (573) 690-5665
- NPI assigned
- May 23, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36582 | MO | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 36582 | MO | Yes |
Addresses
Primary practice location
3205 Pembroke SQ
Jefferson City, MO 65109-5731
Mailing address
3205 Pembroke SQ
Jefferson City, MO 65109-5731
Phone (573) 690-5665
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 246894406 | Medicaid | MO | |
| 32232 | Other | MO | BNDD |
Other providers in Jefferson City, MO
- Sophie Branson
- Sunchandandeep Singh Brar
- Amber Brasier
- Joni M Braun
- Olga Brea Pena
- Rolando Daniel Breier
- Anthony R Brenneke
- Sandra Brenner
- Edwin Dean Breshears
- Maura Breting
All providers in Jefferson City, MO · Specialist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.