MEDICARE: DR. GRACE H. A. THOMAS M.D.

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	207V00000X	Obstetrics & Gynecology Physician	00023622	AL

General Provider Information

NPI Number	:	1861528887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACE H. A. THOMAS M.D.

Provider Business Mailing Address
First Line	:	201 MONROE ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-3735
Country	:	US
Telephone Number	:	334-206-3879
Fax Number	:	334-206-3998

Provider Business Practice Location Address
First Line	:	201 MONROE ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-3735
Country	:	US
Telephone Number	:	334-206-3879
Fax Number	:	334-206-3998

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	04/10/2008

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