Healthcare Provider Details

I. General information

NPI: 1104876010
Provider Name (Legal Business Name): THOMAS A OAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 DIVISION ST S
NORTHFIELD MN
55057-2468
US

IV. Provider business mailing address

710 DIVISION ST S
NORTHFIELD MN
55057-2468
US

V. Phone/Fax

Practice location:
  • Phone: 507-646-1494
  • Fax:
Mailing address:
  • Phone: 507-646-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number21058
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: