Provider Demographics
NPI:1881044089
Name:THOMAS, NATHAN MICHAEL
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5245
Mailing Address - Country:US
Mailing Address - Phone:712-328-8800
Mailing Address - Fax:712-328-8461
Practice Address - Street 1:1801 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1505
Practice Address - Country:US
Practice Address - Phone:515-282-5640
Practice Address - Fax:515-282-2332
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10665207Q00000X
IAMD46785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine