Provider Demographics
NPI:1700126919
Name:THOMASON, RICHARD D (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:THOMASON
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 1:23560 COUNTY ROAD 106
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-8608
Mailing Address - Country:US
Mailing Address - Phone:630-204-8447
Mailing Address - Fax:
Practice Address - Street 1:23560 COUNTY ROAD 106
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-8608
Practice Address - Country:US
Practice Address - Phone:630-204-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028386A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist