Basic Information
| Provider Information | |||||||||
| NPI: | 1275675092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JOEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4625 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056322323 | ||||||||
| FaxNumber: | 4056319315 | ||||||||
| Practice Location | |||||||||
| Address1: | 4625 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056322323 | ||||||||
| FaxNumber: | 4056319315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 06/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 25118 | OK | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 2085R0202X | 106920 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 57118 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.