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1003888108

NPI Code Detail

MEDICARE: THOMAS D DEA PA-C

MEDICARE: THOMAS D DEA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10003775	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00418396	OTHER		RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0210988	OTHER	WA	LABOR & INDUSTRIES
2	000010157088	OTHER		REGENCE BS OF IDAHO
3	6767DE	OTHER	WA	ASURIS NW HEALTH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003888108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS D DEA PA-C

Provider Business Mailing Address
First Line	:	910 N WASHINGTON ST
Second Line	:	SUITE 209
City	:	SPOKANE
State	:	WA
Zip	:	99201-2202
Country	:	US
Telephone Number	:	509-232-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	5633 N LIDGERWOOD ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-1224
Country	:	US
Telephone Number	:	509-482-2460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	12/08/2007

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Directions to “ THOMAS D DEA PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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