Provider Demographics
NPI:1508849985
Name:THOMAS, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
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 1:6112 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4955
Mailing Address - Country:US
Mailing Address - Phone:480-924-4422
Mailing Address - Fax:480-924-8822
Practice Address - Street 1:6112 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4955
Practice Address - Country:US
Practice Address - Phone:480-924-4422
Practice Address - Fax:480-924-8822
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ475295Medicaid
AZ110191782OtherRAILROAD MEDICARE
AZ86080015085259A716OtherTRIWEST
H01494Medicare UPIN
AZ475295Medicaid