Provider Demographics
NPI:1629063235
Name:THOMAS, REXFORD LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:REXFORD
Middle Name:LEE
Last Name:THOMAS
Suffix:JR
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 1:1026 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3445
Mailing Address - Country:US
Mailing Address - Phone:716-712-0851
Mailing Address - Fax:716-712-0853
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3445
Practice Address - Country:US
Practice Address - Phone:716-712-0851
Practice Address - Fax:716-712-0853
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191725208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01977417Medicaid
NY1710862OtherIHA
NY000525722005OtherBC/BS
NY00026031604OtherUNIVERA
NY457959OtherWELLCARE
NYJ400079211Medicare PIN
020054351Medicare PIN
NY1710862OtherIHA
NY01977417Medicaid