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General NPI Number Information
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NPI Number | 1417386400
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Entity Type | Individual
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Provider Name | MR. LAWRENCE T THOMAS JR.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2013
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Last Update Date | 11/11/2013
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Provider Practice Location Address
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Address Line | 1220 W SAND DUNE DR
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City | GILBERT
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State | AZ
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Zip | 85233-5615
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Country | US
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Telephone | 480-235-3456
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Fax | 520-578-3901
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Provider Business Mailing Address
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Address Line | 2621 W VEREDA VERDE
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City | TUCSON
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State | AZ
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Zip | 85746-8001
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Country | US
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Telephone | 480-235-3456
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Fax | 520-578-3901
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 10718
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License Number State | AZ
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