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General NPI Number Information
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NPI Number | 1659343689
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Entity Type | Individual
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Provider Name | KELLY B THOMAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 1830 BLAKE AVE
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4275
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Country | US
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Telephone | 970-945-8503
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Fax | 970-945-0253
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Provider Business Mailing Address
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Address Line | 1830 BLAKE AVE
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4275
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Country | US
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Telephone | 970-945-8503
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Fax | 970-945-0253
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 47625
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35743
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME98103
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 46320
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License Number State | CO
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