Healthcare Provider Details

I. General information

NPI: 1467453597
Provider Name (Legal Business Name): JON V. THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 E DIVISION ST
RIVER FALLS WI
54022-1571
US

IV. Provider business mailing address

720 WASHINGTON AVE SE STE 300
MINNEAPOLIS MN
55414-2904
US

V. Phone/Fax

Practice location:
  • Phone: 715-425-6701
  • Fax:
Mailing address:
  • Phone: 612-672-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number32769
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: