MEDICARE: JASMINE COATLEY-THOMAS MD

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	207R00000X	Internal Medicine Physician	R82789	AZ

General Provider Information

NPI Number	:	1104654359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE COATLEY-THOMAS MD

Provider Business Mailing Address
First Line	:	1103 ENGLISH GREEN LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-6275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 E AJO WAY STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6204
Country	:	US
Telephone Number	:	520-874-2778
Fax Number	:	520-874-3456

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	05/28/2026

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