Healthcare Provider Details

I. General information

NPI: 1427096288
Provider Name (Legal Business Name): HARVEY G THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DIVISION ST
PRESCOTT AZ
86301-1613
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4818
  • Fax: 928-445-4837
Mailing address:
  • Phone: 928-759-5987
  • Fax: 928-458-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number23130
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number23130
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: