Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 11242 | NV |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 11242 | NV |
NPI | 1568461812 |
---|---|
Provider Name | Dr. Michael D Thomas |
First Address | Las Vegas, NV 89128-4337 |
Second Address | Las Vegas, NV 89128-4337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 04/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100504377 | (05) | NV |
C65121 | (02) |