Provider Demographics
NPI:1134284524
Name:THOMAS, THOMAS (DO)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 DESCHUTES CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6028
Mailing Address - Country:US
Mailing Address - Phone:417-848-1176
Mailing Address - Fax:
Practice Address - Street 1:6900 NORTH PECOS ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89806
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO3147207R00000X
MO113156208M00000X, 207R00000X
MOD0113156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248860603Medicaid
MO1134284524OtherNPI
50098003Medicare PIN
MO248860603Medicaid
P00717602Medicare PIN