Provider Demographics
NPI:1376207381
Name:THOMAS, ANTHONY M
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 GERMAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1768
Mailing Address - Country:US
Mailing Address - Phone:651-756-0912
Mailing Address - Fax:
Practice Address - Street 1:2585 GERMAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1768
Practice Address - Country:US
Practice Address - Phone:651-756-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver