Healthcare Provider Details

I. General information

NPI: 1497778559
Provider Name (Legal Business Name): DEBRA JANINE THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CEDAR VALLEY DR SUITE 3A
CEDAR BLUFF VA
24609-9184
US

IV. Provider business mailing address

1100 CEDAR VALLEY DR SUITE 3A
CEDAR BLUFF VA
24609-9184
US

V. Phone/Fax

Practice location:
  • Phone: 276-596-9064
  • Fax: 276-596-9097
Mailing address:
  • Phone: 276-596-9064
  • Fax: 276-596-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0101248544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: