Provider Demographics
NPI:1124006044
Name:THOMAS, DIANE M (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4868 SPARKS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8207
Mailing Address - Country:US
Mailing Address - Phone:775-331-5023
Mailing Address - Fax:775-331-5031
Practice Address - Street 1:4868 SPARKS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-8207
Practice Address - Country:US
Practice Address - Phone:775-331-5023
Practice Address - Fax:775-331-5031
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2021-07-22
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Provider Licenses
StateLicense IDTaxonomies
NV9450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV29D1015353OtherCLIA
NVDQ4188OtherRAILROAD MEDICARE
NV002016817Medicaid
NV29D1015353OtherCLIA
NVV36865Medicare PIN