Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | R9155 | TX |
NPI | 1760663462 |
---|---|
Provider Name | Dr. Elizabeth Michelle Thomas |
First Address | San Antonio, TX 78229-4402 |
Second Address | San Antonio, TX 78229-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2007 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009462900 | (05) | FL |
20A118220 | BLUE SHIELD PROVIDER NUMBER (01) | CA |
391018401 | (05) | TX |