MEDICARE: JUDY SHARON JORDAN 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	207N00000X	Dermatology Physician	H4974	TX
2	207N00000X	Dermatology Physician	39832	NC

General Provider Information

NPI Number	:	1851385439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY SHARON JORDAN THOMAS MD

Provider Business Mailing Address
First Line	:	6926 WASHITA WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2308
Country	:	US
Telephone Number	:	210-698-2388
Fax Number	:

Provider Business Practice Location Address
First Line	:	6926 WASHITA WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2308
Country	:	US
Telephone Number	:	210-698-2388
Fax Number	:

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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