Healthcare Provider Details

I. General information

NPI: 1437445715
Provider Name (Legal Business Name): ALLAN RAY THOMAS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055
US

IV. Provider business mailing address

1320 W MAIN ST
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4151
  • Fax: 220-564-7153
Mailing address:
  • Phone: 220-564-4151
  • Fax: 220-564-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004423
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1098226
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: