Provider Demographics
NPI:1336362656
Name:THOMAS, DAN EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:EUGENE
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 1:1823 N. 1950 W.
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-375-8049
Mailing Address - Fax:801-374-9195
Practice Address - Street 1:1067 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-375-8049
Practice Address - Fax:801-374-9195
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1836191205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT562302331007Medicaid
UT005714808Medicare ID - Type Unspecified
UT562302331007Medicaid