Provider Demographics
NPI:1386670081
Name:THOMAS, JEREMY D (DO)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
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 1:1501 N FLORENCE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3275
Mailing Address - Country:US
Mailing Address - Phone:918-343-8574
Mailing Address - Fax:918-343-8575
Practice Address - Street 1:1501 N FLORENCE AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3179
Practice Address - Country:US
Practice Address - Phone:918-343-8574
Practice Address - Fax:918-343-8575
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4495207X00000X, 207X00000X
MO2005018836207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200197750AMedicaid
11556854OtherCAQH
11556854OtherCAQH