Provider Demographics
NPI:1760789663
Name:THOMAS, JAMES D (RT (R))
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 W MACK AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-3700
Mailing Address - Country:US
Mailing Address - Phone:618-554-4378
Mailing Address - Fax:
Practice Address - Street 1:704 W MACK AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-3700
Practice Address - Country:US
Practice Address - Phone:618-554-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor