Provider Demographics
NPI:1124014717
Name:THOMAS, JOHN H (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 HOSPITAL WAY
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2717
Mailing Address - Country:US
Mailing Address - Phone:208-232-2146
Mailing Address - Fax:208-232-2770
Practice Address - Street 1:755 HOSPITAL WAY
Practice Address - Street 2:SUITE B-3
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2717
Practice Address - Country:US
Practice Address - Phone:208-232-2146
Practice Address - Fax:208-232-2770
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-3883207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDB028OtherBLUE CROSS
1112861Medicare ID - Type Unspecified
D73472Medicare UPIN