Provider Demographics
NPI:1790898849
Name:THOMASON, DWAYNE BRYAN (DO)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:BRYAN
Last Name:THOMASON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1307 TWIN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-9500
Mailing Address - Country:US
Mailing Address - Phone:303-688-4314
Mailing Address - Fax:303-660-8029
Practice Address - Street 1:3 OAKWOOD PARK PLZ
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1887
Practice Address - Country:US
Practice Address - Phone:303-688-0660
Practice Address - Fax:303-660-8029
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO21863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01218635Medicaid
CO01218635Medicaid
CO355518Medicare ID - Type Unspecified