Provider Demographics
NPI:1053135392
Name:THOMAS, RICHARD M (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
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 1:2547 N 1060 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4124
Mailing Address - Country:US
Mailing Address - Phone:801-845-9928
Mailing Address - Fax:801-895-7764
Practice Address - Street 1:2547 N 1060 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4124
Practice Address - Country:US
Practice Address - Phone:801-360-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-12-06
Deactivation Date:2024-11-12
Deactivation Code:
Reactivation Date:2024-11-13
Provider Licenses
StateLicense IDTaxonomies
UT1628511205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery