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General NPI Number Information
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NPI Number | 1003018359
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Entity Type | Organization
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Legal Business Name | JACK M THOMAS MD PLLC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 4101 WESLEY ST STE B
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City | GREENVILLE
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State | TX
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Zip | 75401-5635
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Country | US
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Telephone | 903-454-7555
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Fax | 903-450-4420
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Provider Business Mailing Address
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Address Line | PO BOX 8452
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City | GREENVILLE
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State | TX
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Zip | 75404-8452
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Country | US
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Telephone | 903-454-7555
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Fax | 903-450-4420
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK M THOMAS JR.
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Credential | MD
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Telephone | 903-454-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E4718
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License Number State | TX
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