Provider Demographics
NPI:1134295124
Name:UNRUH, THOMAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:UNRUH
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 1:630 PEVELER DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1520
Mailing Address - Country:US
Mailing Address - Phone:931-200-6346
Mailing Address - Fax:
Practice Address - Street 1:1623 NASHVILLE ST STE 106
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8889
Practice Address - Country:US
Practice Address - Phone:270-726-9080
Practice Address - Fax:270-726-4444
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71398208600000X
PAMD048605L208600000X, 2086S0129X
TNMD00000376232086S0129X
KY45999208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732805Medicare ID - Type Unspecified
TNF44375Medicare UPIN