Basic Information
| Provider Information | |||||||||
| NPI: | 1457365926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 N. NEVADA AVE | ||||||||
| Address2: | SUITE 4001 | ||||||||
| City: | COLRADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809071604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196369393 | ||||||||
| FaxNumber: | 7196369087 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 N NEVADA AVE | ||||||||
| Address2: | SUITE 4001 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196369393 | ||||||||
| FaxNumber: | 7196369087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 189143 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | DR.0037528 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 37528 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31032389 | 05 | CO | MEDICAID |