Provider Demographics
NPI:1184792509
Name:THOMAS, KEITH JAY (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAY
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:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-0005
Mailing Address - Country:US
Mailing Address - Phone:541-575-0499
Mailing Address - Fax:
Practice Address - Street 1:170 FORD RD
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-2009
Practice Address - Country:US
Practice Address - Phone:541-575-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26271208600000X
CAC51666208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027967Medicaid
OR133431Medicare ID - Type Unspecified
OR027967Medicaid