=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558559054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD V THOMAS MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2007
-----------------------------------------------------
Last Update Date | 10/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 N 100 W STE 105
-----------------------------------------------------
City | VERNAL
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84078-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-789-8627
-----------------------------------------------------
Fax | 435-789-6759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 N 100 W STE 105
-----------------------------------------------------
City | VERNAL
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84078-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-789-8627
-----------------------------------------------------
Fax | 435-789-6759
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD V THOMAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 435-789-8627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 56860791205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------