Provider Demographics
NPI:1841266301
Name:THOMASON, HENRY CLAYTON III (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CLAYTON
Last Name:THOMASON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2345 COURT DRIVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2151
Mailing Address - Country:US
Mailing Address - Phone:704-865-0077
Mailing Address - Fax:704-867-6401
Practice Address - Street 1:2345 COURT DRIVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2151
Practice Address - Country:US
Practice Address - Phone:704-865-0077
Practice Address - Fax:704-867-6401
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200000325207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126UJMedicaid
NC2280351Medicare ID - Type Unspecified
H13179Medicare UPIN