Provider Demographics
NPI:1740605120
Name:THOMAS, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SW 52ND ST
Mailing Address - Street 2:APT 604
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6837
Mailing Address - Country:US
Mailing Address - Phone:240-475-9698
Mailing Address - Fax:
Practice Address - Street 1:610 SW 52ND ST
Practice Address - Street 2:APT 604
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6837
Practice Address - Country:US
Practice Address - Phone:240-475-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor