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General NPI Number Information
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NPI Number | 1619978327
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Entity Type | Individual
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Provider Name | ROBERT LEE THOMAS IV MD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 123 N 19TH ST SUITE B301
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City | MIDDLESBORO
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State | KY
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Zip | 40965-2865
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Country | US
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Telephone | 606-248-7509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340
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City | MIDDLESBORO
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State | KY
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Zip | 40965-0340
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Country | US
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Telephone | 606-278-7509
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12835
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License Number State | TN
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