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Individual

DR. GIDDEL G A THOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1515 W FIR ST, PORTALES, NM 88130-5703
(575) 356-6695
(575) 356-5948
Mailing address
PO BOX 843, PORTALES, NM 88130-0843
(575) 356-6695
(575) 356-5948

Taxonomy

Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
MD2009-0687
NM
2080P0207X
Pediatric Hematology & Oncology Physician
ME978766
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
73252875
NM
01
ME98766
MEDICAL LICENCE
FL
Enumeration date
08/16/2007
Last updated
05/07/2018
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