Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 25181 | AL |
NPI | 1083624357 |
---|---|
Provider Name | Dr. Gregory Allen Thomas |
First Address | Birmingham, AL 35211-1333 |
Second Address | Birmingham, AL 35211-1333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09923075 | (05) | AL |