Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 0101248544 | VA |
NPI | 1497778559 |
---|---|
Provider Name | Dr. Debra Janine Thomas |
First Address | Cedar Bluff, VA 24609-9184 |
Second Address | Cedar Bluff, VA 24609-9184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 05/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1467754093 | GROUP NPI (01) | |
1497778559 | (05) | VA |
3810019180 | (05) | WV |
VAA110004 | MEDICARE GROUP PTAN (01) | |
VAA113140 | MEDICARE INDIVIDUAL PTAN (01) |