Provider Demographics
NPI:1508967738
Name:THOMAS, DARIN DEVON (MD)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:DEVON
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:PO BOX 128
Mailing Address - Street 2:202 E THIRD
Mailing Address - City:FERDINAND
Mailing Address - State:IN
Mailing Address - Zip Code:47532-0128
Mailing Address - Country:US
Mailing Address - Phone:812-367-1112
Mailing Address - Fax:812-367-1907
Practice Address - Street 1:202 E THIRD
Practice Address - Street 2:
Practice Address - City:FERDINAND
Practice Address - State:IN
Practice Address - Zip Code:47532
Practice Address - Country:US
Practice Address - Phone:812-367-1112
Practice Address - Fax:812-367-1907
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200002040AMedicaid
IN110130728OtherRAILROAD MEDICARE
IN000000091521OtherANTHEM
IN200002040AMedicaid
IN110130728OtherRAILROAD MEDICARE