Individual
MR. BENNY EARL THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
215 NORTH ST, WAYNESVILLE, MO 65583
(573) 774-6279
(573) 774-5626
Mailing address
PO BOX 4503, 215 NORTH ST., WAYNESVILLE, MO 65583
(573) 774-6279
(573) 774-5626
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34548
MO
208VP0000X
Pain Medicine Physician
Primary
34548
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240424606
—
MO
Enumeration date
07/25/2006
Last updated
03/14/2018
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