Provider Demographics
NPI:1396210316
Name:THOMAS DERMATOLOGY
Entity Type:Organization
Organization Name:THOMAS DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-430-5333
Mailing Address - Street 1:866 SEVEN HILLS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4376
Mailing Address - Country:US
Mailing Address - Phone:702-430-5333
Mailing Address - Fax:
Practice Address - Street 1:866 SEVEN HILLS DR STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4376
Practice Address - Country:US
Practice Address - Phone:702-430-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1730101023Medicaid