MEDICARE: PAUL THOMAS DO

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	207Q00000X	Family Medicine Physician	02917	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427026749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL THOMAS DO

Provider Business Mailing Address
First Line	:	PO BOX 1824
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52406-1824
Country	:	US
Telephone Number	:	319-369-4505
Fax Number	:	319-369-4677

Provider Business Practice Location Address
First Line	:	900 BANK CT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9477
Country	:	US
Telephone Number	:	319-849-9000
Fax Number	:	319-849-2325

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

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	10/25/2007

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