Healthcare Provider Details

I. General information

NPI: 1275675092
Provider Name (Legal Business Name): JOEL R THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 S WESTERN AVE
OKLAHOMA CITY OK
73109-3831
US

IV. Provider business mailing address

4625 S WESTERN AVE
OKLAHOMA CITY OK
73109-3831
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-2323
  • Fax: 405-631-9315
Mailing address:
  • Phone: 405-632-2323
  • Fax: 405-631-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25118
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberT4686
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number106920
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21802
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57118
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number67541
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME174325
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25118
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: