Provider Demographics
NPI:1801818265
Name:THOMAS, EDWARD KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:KENT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24005 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-7485
Mailing Address - Country:US
Mailing Address - Phone:580-421-1191
Mailing Address - Fax:580-421-6167
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-421-1127
Practice Address - Fax:580-421-6167
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK12506207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE94920Medicare UPIN