Provider Demographics
NPI:1003888108
Name:DEA, THOMAS D (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:DEA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N WASHINGTON ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2202
Mailing Address - Country:US
Mailing Address - Phone:509-232-1173
Mailing Address - Fax:
Practice Address - Street 1:5633 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1224
Practice Address - Country:US
Practice Address - Phone:509-482-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210988OtherLABOR & INDUSTRIES
000010157088OtherREGENCE BS OF IDAHO
WA6767DEOtherASURIS NW HEALTH
P00418396OtherRAIL ROAD MEDICARE
WA8417271Medicaid
G8860928Medicare PIN
WAG8864194Medicare PIN
P00418396OtherRAIL ROAD MEDICARE