Provider Demographics
NPI:1083624944
Name:THOMAS, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 NORTHSTAR CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8021
Mailing Address - Country:US
Mailing Address - Phone:719-248-3889
Mailing Address - Fax:
Practice Address - Street 1:6833 NORTHSTAR CIR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-8021
Practice Address - Country:US
Practice Address - Phone:719-248-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071199207X00000X
WA61248697207X00000X
UT12645018-1205207X00000X
CO32382207X00000X
MEMD25649207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01323823Medicaid
MI3392924Medicaid
MI09-31941OtherPHP
MIM10000934OtherCHAMPUS
MIRT071199OtherSTATE LICENSE
MI0A36256006Medicare ID - Type Unspecified
MIRT071199OtherSTATE LICENSE