Provider Demographics
NPI:1609856095
Name:THOMAS, QUINTON (MD)
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:
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 1:1475 TERMINAL WAY
Mailing Address - Street 2:SUITE A1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3430
Mailing Address - Country:US
Mailing Address - Phone:775-331-6400
Mailing Address - Fax:775-331-6111
Practice Address - Street 1:1475 TERMINAL WAY
Practice Address - Street 2:SUITE A1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3430
Practice Address - Country:US
Practice Address - Phone:775-331-6400
Practice Address - Fax:775-331-6111
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95856Medicare UPIN
100273Medicare ID - Type Unspecified