Individual
CLARENCE HENRY THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6021 KENTUCKY AVE, INDIANAPOLIS, IN 46221
(317) 856-5565
(317) 856-1202
Mailing address
6021 KENTUCKY AVE, INDIANAPOLIS, IN 46221
(317) 856-5565
(317) 856-1202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027581
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000386020
ANTHEM
IN
05
—
100060820
—
IN
Enumeration date
12/08/2005
Last updated
03/18/2021
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