Provider Demographics
NPI:1669456042
Name:CLEMENTS, THOMAS IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:IRA
Last Name:CLEMENTS
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 1:200 SW FRAZIER CIR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2800
Mailing Address - Country:US
Mailing Address - Phone:785-232-2044
Mailing Address - Fax:785-232-5567
Practice Address - Street 1:200 SW FRAZIER CIR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2800
Practice Address - Country:US
Practice Address - Phone:785-232-2044
Practice Address - Fax:785-232-5567
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSI35521Medicare UPIN
KS104766Medicare ID - Type Unspecified