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General NPI Number Information
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NPI Number | 1871090142
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Entity Type | Individual
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Provider Name | JONATHAN WILLIAM THOMA MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 4410 REGENT ST
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City | MADISON
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State | WI
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Zip | 53705-4901
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Country | US
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Telephone | 608-233-9746
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Fax | 608-233-0026
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Provider Business Mailing Address
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Address Line | PSC 78 BOX 6739
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City | APO
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State | AP
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Zip | 96326-0068
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2018028929
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License Number State | MO
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