Provider Demographics
NPI:1285678110
Name:THOMAS, MARK DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4800 PALO DURO AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1112
Mailing Address - Country:US
Mailing Address - Phone:505-888-4596
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5153
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:505-256-5743
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM501 VETPRO363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical