Provider Demographics
NPI:1144354333
Name:JEFFORY F THOMAS, MD PA
Entity type:Organization
Organization Name:JEFFORY F THOMAS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-831-3033
Mailing Address - Street 1:3510 RICHMOND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0705
Mailing Address - Country:US
Mailing Address - Phone:903-831-3033
Mailing Address - Fax:903-831-3032
Practice Address - Street 1:3510 RICHMOND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0705
Practice Address - Country:US
Practice Address - Phone:903-831-3033
Practice Address - Fax:903-831-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0219174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0219OtherLICENSE
TX00666YMedicare ID - Type Unspecified
TXG16035Medicare UPIN