Provider Demographics
NPI:1730101023
Name:THOMAS, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
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 1:9097 W POST RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2411
Mailing Address - Country:US
Mailing Address - Phone:702-430-5333
Mailing Address - Fax:702-430-5335
Practice Address - Street 1:9097 W POST RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2411
Practice Address - Country:US
Practice Address - Phone:702-430-5333
Practice Address - Fax:702-430-5335
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5901207ND0101X
AZ65027207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105879OtherMEDICARE PTAN
NV070003256OtherRAILROAD MEDICARE
E28556Medicare UPIN
NVV105879Medicare PIN