Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G071045 | CA |
Y | 208200000X | Surgeon | G071045 | CA |
Y | 208600000X | Surgeon | G071045 | CA |
N | 2086X0206X | Surgical Oncologist | 256245 | NY |
N | 2086X0206X | Surgical Oncologist | 30439 | SC |
N | 2086X0206X | Surgical Oncologist | G071045 | CA |
NPI | 1275733016 |
---|---|
Provider Name | Dr. Gail Elizabeth Thomas |
First Address | Belleville, IL 62223-3474 |
Second Address | Belleville, IL 62223-3474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 16/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8157 | MEDICARE PTAN (01) | SC |
F01874 | (02) | SC |