Provider Demographics
NPI:1750531729
Name:THOMAS, CHARLES RAY II (RN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RAY
Last Name:THOMAS
Suffix:II
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13022 HUNTERS CHASE DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7899
Mailing Address - Country:US
Mailing Address - Phone:405-388-8857
Mailing Address - Fax:
Practice Address - Street 1:13022 HUNTERS CHASE DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7899
Practice Address - Country:US
Practice Address - Phone:405-388-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657463372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider