Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01053135A | IN |
N | 2080P0205X | Pediatric Endocrinologist | 01053135A | IN |
NPI | 1013973536 |
---|---|
Provider Name | Pamela Thomas |
First Address | Fort Wayne, IN 46804-4140 |
Second Address | Fort Wayne, IN 46804-4140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 11/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200288570A | (05) | IN |
G16353 | (02) | IN |