Provider Demographics
NPI:1538331418
Name:THOMAS, ERIC DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
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 1:130 MARVIN RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6100
Mailing Address - Country:US
Mailing Address - Phone:360-923-1111
Mailing Address - Fax:360-455-8677
Practice Address - Street 1:130 MARVINRD SE #112
Practice Address - Street 2:EXPRESS URGENT CARE
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-923-1111
Practice Address - Fax:360-455-8677
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8806633Medicare PIN
WAH48337Medicare UPIN