1891897658 NPI number — DOUGLAS A. THOMAS, MD

Table of content: (NPI 1891897658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891897658 NPI number — DOUGLAS A. THOMAS, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS A. THOMAS, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THOMAS DERMATOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891897658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4488 S PECOS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89121-5030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-430-5333
Provider Business Mailing Address Fax Number:
702-430-5335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4488 S PECOS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121-5030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-430-5333
Provider Business Practice Location Address Fax Number:
702-430-5335
Provider Enumeration Date:
09/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-430-5333

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  5901 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)