Provider Demographics
NPI:1659379527
Name:THOMAS, JAMES ROBERT (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD, 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 6011
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-6011
Mailing Address - Country:US
Mailing Address - Phone:928-681-4273
Mailing Address - Fax:928-681-4276
Practice Address - Street 1:3939 STOCKTON HILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3247
Practice Address - Country:US
Practice Address - Phone:928-681-4273
Practice Address - Fax:928-681-4276
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD22397207VG0400X, 207VX0000X
SDBOARD ELIGIBLE207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0802940OtherBLUE CROSS BLUE SHIELD
CA201257OtherALLOPATHIC LICENSE CA
UTZ0836Medicaid
AZ2007300OtherCIGNA HMO
7959OtherCANADIAN MD LICENSE
AZ4735OtherATENA
AZ17089OtherALLOPATHIC LICENSE AZ
AZ269432Medicaid
CAXPY075910Medicaid
AZ1Z9856OtherHEALTH NET
AZ860843193N3OtherPACIFIC CARE
AZ3580150.02OtherCIGNA PPO
AZ860843193N3OtherPACIFIC CARE
AZ269432Medicaid