Healthcare Provider Details

I. General information

NPI: 1336578137
Provider Name (Legal Business Name): JEFFREY THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 CROWLEY RD
COLUMBUS OH
43207-3879
US

IV. Provider business mailing address

317 CROWLEY RD
COLUMBUS OH
43207-3879
US

V. Phone/Fax

Practice location:
  • Phone: 614-893-8340
  • Fax:
Mailing address:
  • Phone: 614-893-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRH766005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: