Individual
GARY LANE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1705 E 19TH ST STE 302, HOLLIMAN MEDICAL BUILDING, TULSA, OK 74104-5410
(918) 748-7585
Mailing address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 403-7054
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28565
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200338060A
—
OK
01
—
28565
OKLAHOMA MEDICAL LICENSE
OK
Enumeration date
04/23/2011
Last updated
11/19/2024
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