Healthcare Provider Details

I. General information

NPI: 1215974779
Provider Name (Legal Business Name): MATTHEW ROY THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 9TH ST
BISMARCK ND
58501-4507
US

IV. Provider business mailing address

401 N 9TH ST
BISMARCK ND
58501-4507
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-6000
  • Fax: 701-530-6430
Mailing address:
  • Phone: 701-530-6000
  • Fax: 701-530-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5240
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: