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General NPI Number Information
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NPI Number | 1760665186
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Entity Type | Organization
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Legal Business Name | NATHAN B THOMAS DPM
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 110 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-8116
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Country | US
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Telephone | 406-542-2108
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Fax | 406-542-2195
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Provider Business Mailing Address
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Address Line | 110 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-8116
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Country | US
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Telephone | 406-542-2108
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Fax | 406-542-2195
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN B THOMAS
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Credential | DPM
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Telephone | 406-542-2108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 146
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License Number State | MT
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