Provider Demographics
NPI:1497799555
Name:THOMAS, DOUGLAS A (PA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6419
Mailing Address - Street 2:HEART CENTER CARDIOLOGY
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-633-2517
Mailing Address - Fax:541-633-2569
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:HEART CENTER CARDIOLOGY
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-633-2517
Practice Address - Fax:541-633-2569
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL 360363A00000X
ORPA156119363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYP87494Medicare UPIN