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NPI Code Detail

MEDICARE: JEAN K THOMAS MD

MEDICARE: JEAN K 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
12084N0400XNeurology PhysicianL2777TX
22084N0400XNeurology PhysicianM-12101ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881695534
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN K THOMAS MD
Provider Business Mailing Address
First Line : 415 6TH STREET
Second Line : ATTN: PHYSICIAN SERVICES
City : LEWISTON
State : ID
Zip : 83501-2424
Country : US
Telephone Number : 208-750-7462
Fax Number : 208-750-7467
Provider Business Practice Location Address
First Line : 415 6TH ST
Second Line :
City : LEWISTON
State : ID
Zip : 83501-2431
Country : US
Telephone Number : 208-750-7474
Fax Number : 208-799-5729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 12/26/2024

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Directions to “ JEAN K THOMAS MD” Practice Location

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