Provider Demographics
NPI:1467489872
Name:THOMAS, MERRILL A (DO)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:A
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 1:46 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4301
Mailing Address - Country:US
Mailing Address - Phone:316-214-6269
Mailing Address - Fax:405-341-7074
Practice Address - Street 1:46 E 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4301
Practice Address - Country:US
Practice Address - Phone:316-214-6269
Practice Address - Fax:405-341-7074
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102870OtherBCBS
KS100234950CMedicaid
KS1447OtherPHS
KS167043OtherCOVENTRY
KS300567OtherHPK
KS300567OtherHPK
KS102870OtherBCBS