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Organization
CLARENCE H THOMAS MD LLC
Active
Organization
CLARENCE H THOMAS MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE HENRY THOMAS MD (OWNER)
(317) 856-5565
Entity
Organization
Contact information
Practice address
6021 KENTUCKY AVENUE, INDIANAPOLIS, IN 46221
(317) 856-5565
(317) 856-1202
Mailing address
6021 KENTUCKY AVE, INDIANAPOLIS, IN 46221-9701
(317) 856-5565
(317) 856-1202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384605
ANTHEM
IN
05
—
200365090
—
IN
Enumeration date
09/20/2006
Last updated
03/26/2013
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