Healthcare Provider Details

I. General information

NPI: 1063581452
Provider Name (Legal Business Name): CRAIG R. THOMAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP STREET SUITE 107
FAIRBANKS AK
99701-5936
US

IV. Provider business mailing address

PO BOX 74271
FAIRBANKS AK
99707-4271
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-4101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3924
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: