Provider Demographics
NPI:1912205360
Name:ROBERT JAY THOMAS JR PHD PC
Entity Type:Organization
Organization Name:ROBERT JAY THOMAS JR PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-867-8550
Mailing Address - Street 1:675 E 2100 S
Mailing Address - Street 2:STE 250
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-5318
Mailing Address - Country:US
Mailing Address - Phone:801-867-8550
Mailing Address - Fax:801-484-3862
Practice Address - Street 1:675 E 2100 S
Practice Address - Street 2:STE 250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-5318
Practice Address - Country:US
Practice Address - Phone:801-867-8550
Practice Address - Fax:801-484-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT22-110817-2501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007519Medicare PIN