Healthcare Provider Details

I. General information

NPI: 1871933697
Provider Name (Legal Business Name): ANDREW JAMES THOMAS MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ALPHA WAY
CLE ELUM WA
98922-1045
US

IV. Provider business mailing address

201 ALPHA WAY
CLE ELUM WA
98922-1045
US

V. Phone/Fax

Practice location:
  • Phone: 509-674-5331
  • Fax: 509-674-5034
Mailing address:
  • Phone: 509-674-5331
  • Fax: 509-674-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60799264
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: