Provider Demographics
NPI:1982918488
Name:DRAHOS, THOMAS GREGORY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GREGORY
Last Name:DRAHOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361-9436
Mailing Address - Country:US
Mailing Address - Phone:319-444-0147
Mailing Address - Fax:
Practice Address - Street 1:1765 LININGER LN
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-2316
Practice Address - Country:US
Practice Address - Phone:319-665-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant