MEDICARE: REBECCA SUZANNE ROE THOMASSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2015007731	MO

General Provider Information

NPI Number	:	1083090088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA SUZANNE ROE THOMASSON PA-C

Provider Business Mailing Address
First Line	:	319 S SILVER SPRINGS RD STE C
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6308
Country	:	US
Telephone Number	:	573-334-4263
Fax Number	:	573-334-3699

Provider Business Practice Location Address
First Line	:	319 S SILVER SPRINGS RD STE C
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6308
Country	:	US
Telephone Number	:	573-334-4263
Fax Number	:	573-334-3699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	09/14/2023

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