Provider Demographics
NPI:1851321434
Name:THOMAS, ROGER W (PAC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9585363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN89D48THOtherMNBS #
MN142352OtherUCARE #
ND19315OtherNDBS #
MN517450300Medicaid
MNDA9021027003OtherPREFERRED ONE #
MNP00979630OtherRAILROAD MEDICARE
MN0110929OtherMEDICA #
MN1156275OtherAMERICA'S PPO/ARAZ #
MN19315OtherNDBS #
MNHP38586OtherHEALTHPARTNERS #
MN89D48THOtherMNBS #
MN19315OtherNDBS #
MN142352OtherUCARE #
ND19315OtherNDBS #
P25454Medicare UPIN