Individual
MARY THOMASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
42607
WI
207R00000X
Internal Medicine Physician
Primary
MD27320
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212980
—
OR
05
—
34245500
—
WI
01
—
P00604885
RR MEDICARE - PHS
OR
Enumeration date
03/30/2006
Last updated
03/25/2021
Update your record
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