MEDICARE: DR. THOMAS CORDELL THOMAS M.D.

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	28478	MO

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
2	01832015	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1790787059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS CORDELL THOMAS M.D.

Provider Business Mailing Address
First Line	:	110 WESTWOODS DR.
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1218
Country	:	US
Telephone Number	:	816-781-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 WESTWOODS DR
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1181
Country	:	US
Telephone Number	:	816-781-6127
Fax Number	:	816-792-2265

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/07/2010

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