Healthcare Provider Details

I. General information

NPI: 1144498585
Provider Name (Legal Business Name): MARK DONALD THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S PARKER RD SUITE A106
DENVER CO
80231-2758
US

IV. Provider business mailing address

5000 CHESHIRE LN N
PLYMOUTH MN
55446-3706
US

V. Phone/Fax

Practice location:
  • Phone: 303-755-1733
  • Fax: 303-306-9340
Mailing address:
  • Phone: 888-333-9152
  • Fax: 763-268-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number200431
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: