Provider Demographics
NPI:1790817336
Name:STRAIN, THOMAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:STRAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:538 N. PASEO DE ONATE
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-753-5815
Practice Address - Street 1:1235 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4219
Practice Address - Country:US
Practice Address - Phone:505-425-6788
Practice Address - Fax:505-425-5408
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2018-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA308106207Q00000X
NM87158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000R6753Medicaid
NM349716301Medicare PIN
NM321838Medicare ID - Type UnspecifiedLAS VEGAS CLINIC