Healthcare Provider Details

I. General information

NPI: 1659379527
Provider Name (Legal Business Name): JAMES ROBERT THOMAS PH.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 STOCKTON HILL RD SUITE C
KINGMAN AZ
86409-3247
US

IV. Provider business mailing address

PO BOX 6011
KINGMAN AZ
86402-6011
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-4273
  • Fax: 928-681-4276
Mailing address:
  • Phone: 928-681-4273
  • Fax: 928-681-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number22397
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberBOARD ELIGIBLE
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number22397
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: