1184761702 NPI number — STEPHANIE THOMAS M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184761702 NPI number — STEPHANIE THOMAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
STEPHANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVID
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184761702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 GASTON AVE
Provider Second Line Business Mailing Address:
SUITE 190P
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75214-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-619-6550
Provider Business Mailing Address Fax Number:
469-334-0507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 GASTON AVE
Provider Second Line Business Practice Location Address:
SUITE 190P
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75214-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-619-6550
Provider Business Practice Location Address Fax Number:
469-334-0507
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  P2795 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02713486 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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