Healthcare Provider Details

I. General information

NPI: 1912777285
Provider Name (Legal Business Name): WILLIE DEVONTE THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S DAHLIA CIR APT G-305
DENVER CO
80246-3313
US

IV. Provider business mailing address

560 S DAHLIA CIR APT G-305
DENVER CO
80246-3313
US

V. Phone/Fax

Practice location:
  • Phone: 720-319-1213
  • Fax:
Mailing address:
  • Phone: 720-319-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: