Provider Demographics
NPI:1568453587
Name:THOMAS, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
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 1:240 ENON RD
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-1024
Mailing Address - Country:US
Mailing Address - Phone:937-864-2742
Mailing Address - Fax:937-864-2775
Practice Address - Street 1:240 ENON RD
Practice Address - Street 2:
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1024
Practice Address - Country:US
Practice Address - Phone:937-864-2742
Practice Address - Fax:937-864-2775
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2893310Medicaid
P00667159Medicare PIN
4248631Medicare PIN