Provider Demographics
NPI:1912777285
Name:THOMAS, WILLIE DEVONTE
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:DEVONTE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S DAHLIA CIR APT G-305
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3313
Mailing Address - Country:US
Mailing Address - Phone:720-319-1213
Mailing Address - Fax:
Practice Address - Street 1:560 S DAHLIA CIR APT G-305
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3313
Practice Address - Country:US
Practice Address - Phone:720-319-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications