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NPI Code Detail

MEDICARE: JERRY FRANK THOMAS PA-C

MEDICARE: JERRY FRANK THOMAS 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
1363A00000XPhysician AssistantMA051584PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113742206OTHERCAQH

General Provider Information

NPI Number : 1720084437
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY FRANK THOMAS PA-C
Provider Business Mailing Address
First Line : 2315 MYRTLE ST STE L90
Second Line :
City : ERIE
State : PA
Zip : 16502-4607
Country : US
Telephone Number : 814-452-7575
Fax Number :
Provider Business Practice Location Address
First Line : 2315 MYRTLE ST STE L90
Second Line :
City : ERIE
State : PA
Zip : 16502-4607
Country : US
Telephone Number : 814-452-7575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 03/15/2024

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Directions to “ JERRY FRANK THOMAS PA-C” Practice Location

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