Healthcare Provider Details

I. General information

NPI: 1578566410
Provider Name (Legal Business Name): JAMES RANDALL THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRECKENRIDGE ST STE 302
OWENSBORO KY
42303-0877
US

IV. Provider business mailing address

1000 BRECKENRIDGE ST STE 302
OWENSBORO KY
42303-0877
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-3445
  • Fax: 270-688-3444
Mailing address:
  • Phone: 270-688-3445
  • Fax: 270-688-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number49480
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberTP385
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number43862
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: