MEDICARE: MARK DONALD THOMAS

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	237700000X	Hearing Instrument Specialist	200431	CO

General Provider Information

NPI Number	:	1144498585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK DONALD THOMAS

Provider Business Mailing Address
First Line	:	5000 CHESHIRE LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-3706
Country	:	US
Telephone Number	:	888-333-9152
Fax Number	:	763-268-4240

Provider Business Practice Location Address
First Line	:	1402 S PARKER RD
Second Line	:	SUITE A106
City	:	DENVER
State	:	CO
Zip	:	80231-2758
Country	:	US
Telephone Number	:	303-755-1733
Fax Number	:	303-306-9340

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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