Healthcare Provider Details

I. General information

NPI: 1285740183
Provider Name (Legal Business Name): CORNELIUS B THOMAS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MONTCLAIR RD STE 470 MONTCLAIR RHEUMATOLOGY PC
BIRMINGHAM AL
35213
US

IV. Provider business mailing address

880 MONTCLAIR RD STE 470 MONTCLAIR RHEUMATOLOGY PC
BIRMINGHAM AL
35213
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-2758
  • Fax: 205-592-0318
Mailing address:
  • Phone: 205-591-2758
  • Fax: 205-592-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number00008825
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: