Individual
MRS. DIANE SUE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
311 W HIGH ST, LEBANON, KY 40033
(270) 692-5811
(270) 692-3863
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4607
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
32504
KY
2080A0000X
Pediatric Adolescent Medicine Physician
32504
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64325046
—
KY
Enumeration date
04/24/2006
Last updated
12/15/2020
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