Provider Demographics
NPI:1801892369
Name:THOMAS, EDWARD DONNALL JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DONNALL
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:E
Other - Middle Name:DONNALL
Other - Last Name:THOMAS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1898 TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-8684
Mailing Address - Country:US
Mailing Address - Phone:406-538-2661
Mailing Address - Fax:
Practice Address - Street 1:1898 TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-8684
Practice Address - Country:US
Practice Address - Phone:406-538-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0056303Medicaid
MTC972650Medicare UPIN