Individual
DOROTHY ELLIOTT THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
305 W BROADWAY, SUITE 104, LOUISVILLE, KY 40202-2129
(502) 585-2924
(502) 585-2931
Mailing address
305 W BROADWAY, SUITE 104, LOUISVILLE, KY 40202-2129
(502) 585-2924
(502) 585-2931
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
26885
KY
208000000X
Pediatrics Physician
32081
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50051042
PASSPORT PROVIDER #
KY
05
—
7100241290
—
KY
Enumeration date
12/19/2012
Last updated
09/04/2013
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