Provider Demographics
NPI:1467444323
Name:THOMAS, WINSTON S (MD)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:S
Last Name:THOMAS
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 1:3033 N. CENTRAL AVE.
Mailing Address - Street 2:STE. 610
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2819
Mailing Address - Country:US
Mailing Address - Phone:602-266-1556
Mailing Address - Fax:602-279-5333
Practice Address - Street 1:3033 N. CENTRAL AVE
Practice Address - Street 2:STE 610
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2819
Practice Address - Country:US
Practice Address - Phone:602-266-1556
Practice Address - Fax:602-279-5333
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ221250Medicaid
AZF21735Medicare UPIN
AZ221250Medicaid