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General NPI Number Information
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NPI Number | 1336361443
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Entity Type | Individual
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Provider Name | GERALD L THOMAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 44555 WOODWARD AVE SUITE 105
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City | PONTIAC
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State | MI
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Zip | 48341-5031
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Country | US
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Telephone | 248-335-2977
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Fax | 248-858-3880
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Provider Business Mailing Address
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Address Line | 44555 WOODWARD AVE SUITE 105
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City | PONTIAC
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State | MI
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Zip | 48341-5031
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Country | US
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Telephone | 248-335-2977
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Fax | 248-858-3880
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5601003758
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License Number State | MI
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