Provider Demographics
NPI:1831299809
Name:THOMAS, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:THOMAS
Suffix:
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 1:11260 OLD SEWARD HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3038
Mailing Address - Country:US
Mailing Address - Phone:907-433-5130
Mailing Address - Fax:
Practice Address - Street 1:11260 OLD SEWARD HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3038
Practice Address - Country:US
Practice Address - Phone:907-433-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD81073Medicaid
F67498Medicare UPIN
AKMD81073Medicaid