Provider Demographics
NPI:1023100773
Name:THOMAS, DAMON J (MD)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 505673
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5673
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:102 CORTNEY LN
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633-9192
Practice Address - Country:US
Practice Address - Phone:417-269-2264
Practice Address - Fax:417-269-2270
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO113023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205040108Medicaid
128206OtherBLUE CROSS OF MO
H18212Medicare UPIN
128206OtherBLUE CROSS OF MO