Healthcare Provider Details

I. General information

NPI: 1275733016
Provider Name (Legal Business Name): GAIL ELIZABETH THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 HICKORY BND
BELLEVILLE IL
62223-3474
US

IV. Provider business mailing address

324 HICKORY BND
BELLEVILLE IL
62223-3474
US

V. Phone/Fax

Practice location:
  • Phone: 618-604-9926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG071045
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG071045
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG071045
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number30439
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number256245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: