Provider Demographics
NPI:1710974506
Name:THOMS, MATTHEW W (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:THOMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-616-7630
Mailing Address - Fax:580-237-7516
Practice Address - Street 1:707 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7286
Practice Address - Country:US
Practice Address - Phone:580-616-7630
Practice Address - Fax:580-237-7516
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1103363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100210100AMedicaid
OKP01318823OtherRAILROAD MEDICARE
OKP33752Medicare UPIN
OK100210100AMedicaid
OK100210100AMedicaid