Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 01067563A | IN |
N | 207RC0000X | Internist - Cardiovascular Disease | Q5294 | TX |
NPI | 1003078312 |
---|---|
Provider Name | Dr. Dustin M Thomas |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
471550YR99 | MEDICARE (01) | TX |