Provider Demographics
NPI:1265637151
Name:THOMAS, JOHN REGGIE (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REGGIE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 R ST
Mailing Address - Street 2:100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3799
Mailing Address - Country:US
Mailing Address - Phone:402-465-4545
Mailing Address - Fax:402-465-9011
Practice Address - Street 1:4545 R ST
Practice Address - Street 2:100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3799
Practice Address - Country:US
Practice Address - Phone:402-465-4545
Practice Address - Fax:402-465-9011
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1028207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47071768613Medicaid
NE47071768613Medicaid