Healthcare Provider Details

I. General information

NPI: 1336360064
Provider Name (Legal Business Name): STEVEN O THOMAS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 N MOLTER RD
LIBERTY LAKE WA
99019-7570
US

IV. Provider business mailing address

2207 N MOLTER RD
LIBERTY LAKE WA
99019-7570
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-5850
  • Fax: 509-473-5500
Mailing address:
  • Phone: 509-473-5850
  • Fax: 509-473-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberMD00015869
License Number StateWA

VIII. Authorized Official

Name: DIRENDIA SHACKELFORD
Title or Position: MANAGED CARE SPECIALIST
Credential:
Phone: 800-654-0889