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General NPI Number Information
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NPI Number | 1083665582
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Entity Type | Individual
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Provider Name | GORDON M THOMAS D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 79 NORTH ST GRANVILLE FAMILY HEALTH CENTER
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City | GRANVILLE
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State | NY
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Zip | 12832-1137
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Country | US
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Telephone | 518-642-0612
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Fax | 518-642-0693
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Provider Business Mailing Address
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Address Line | 100 PARK STREET GLENS FALLS HOSPITAL - CREDENTIALING
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City | GLENS FALLS
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State | NY
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Zip | 12801-0304
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Country | US
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Telephone | 518-926-5924
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Fax | 518-926-6983
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 140385
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License Number State | NY
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