Provider Demographics
NPI:1699746925
Name:THOMAS, RICKY ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:ALLAN
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 1:1311 E GENERAL CAVAZOS BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7150
Mailing Address - Country:US
Mailing Address - Phone:361-595-9746
Mailing Address - Fax:469-609-0619
Practice Address - Street 1:1311 E GENERAL CAVAZOS BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7150
Practice Address - Country:US
Practice Address - Phone:361-595-9746
Practice Address - Fax:469-609-0619
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36058207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011JHMedicaid
NC2174297CMedicare ID - Type Unspecified
D15607Medicare UPIN