Healthcare Provider Details

I. General information

NPI: 1730101023
Provider Name (Legal Business Name): DOUGLAS THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 W POST RD SUITE 100
LAS VEGAS NV
89148-2411
US

IV. Provider business mailing address

9097 W POST RD SUITE 100
LAS VEGAS NV
89148-2411
US

V. Phone/Fax

Practice location:
  • Phone: 702-430-5333
  • Fax: 702-430-5335
Mailing address:
  • Phone: 702-430-5333
  • Fax: 702-430-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number5901
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number65027
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: