Basic Information
| Provider Information | |||||||||
| NPI: | 1336288166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2128 | ||||||||
| Address2: | 14 MEDICAL PARK LOOP | ||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287792128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285867610 | ||||||||
| FaxNumber: | 8285867615 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 MEDICAL PARK LOOP | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287795221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285867610 | ||||||||
| FaxNumber: | 8285867615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 10/17/2007 | ||||||||
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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 | 207R00000X | 9600751 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 9600751 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 2085R0001X | 9600751 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 011T7 | 01 | BCBS OF NC | OTHER | 8982549 | 05 | NC | MEDICAID | 89011T7 | 05 | NC | MEDICAID |