Healthcare Provider Details

I. General information

NPI: 1881847887
Provider Name (Legal Business Name): LEONARD D THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 GOAT SPRINGS RD TAOS - PICURIS INDIAN HEALTH CENTER
TAOS NM
87571
US

IV. Provider business mailing address

PO BOX 1946 TAOS - PICURIS HEALTH CENTER
TAOS NM
87571
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-4224
  • Fax: 575-751-5210
Mailing address:
  • Phone: 575-758-4224
  • Fax: 575-751-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01047363A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: