Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO20413 | OR |
NPI | 1649204116 |
---|---|
Provider Name | Michael E Thomas |
First Address | Ashland, OR 97520-2125 |
Second Address | Ashland, OR 97520-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150137 | (05) | OR |
D93066 | (02) | OR |