Provider Demographics
NPI:1003453580
Name:THOMAS, IRA ARTHUR JR (APRN)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:ARTHUR
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 N MARTIN LUTHER KING AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-1408
Mailing Address - Country:US
Mailing Address - Phone:405-493-9652
Mailing Address - Fax:
Practice Address - Street 1:2004 N MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-1408
Practice Address - Country:US
Practice Address - Phone:405-493-9652
Practice Address - Fax:405-944-8223
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK94467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily