Provider Demographics
NPI:1881688968
Name:THOMAS, WAYNE ERIC (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ERIC
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 1:2828 HIGHWAY 31 S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1510
Mailing Address - Country:US
Mailing Address - Phone:256-351-1591
Mailing Address - Fax:
Practice Address - Street 1:2828 HIGHWAY 31 S
Practice Address - Street 2:SUITE 109
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1510
Practice Address - Country:US
Practice Address - Phone:256-351-1591
Practice Address - Fax:256-351-1596
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
63-1004625OtherCOMMERCIAL
AL000019709Medicaid
AL51019709OtherBLUE CROSS
AL000019709Medicaid
63-1004625OtherCOMMERCIAL