Provider Demographics
NPI:1750320305
Name:THOMAS, JOSEPH DEER JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DEER
Last Name:THOMAS
Suffix:JR
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:PO BOX 636
Mailing Address - Street 2:606 R PINCKNEY ST.
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-0636
Mailing Address - Country:US
Mailing Address - Phone:843-398-8838
Mailing Address - Fax:843-398-8839
Practice Address - Street 1:606 R PINCKNEY STREET
Practice Address - Street 2:
Practice Address - City:MC CLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458
Practice Address - Country:US
Practice Address - Phone:843-398-8838
Practice Address - Fax:843-398-8839
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09827207PE0004X, 207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC098272Medicaid
SCP00313042OtherRR MEDICARE
SC080180703OtherRR MEDICARE
SC080180703OtherRR MEDICARE
SCP00313042OtherRR MEDICARE
SC098272Medicaid
SCD470704889Medicare PIN
SC1700899572Medicare PIN