Provider Demographics
NPI:1548490733
Name:THOMAS, DAVID L
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
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 1:1483 BAMBOO LN
Mailing Address - Street 2:
Mailing Address - City:YIGO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-1201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1483 BAMBOO LN
Practice Address - Street 2:
Practice Address - City:YIGO
Practice Address - State:GU
Practice Address - Zip Code:96929-1201
Practice Address - Country:US
Practice Address - Phone:671-366-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians