Individual
JEAN K THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 750-7474
(208) 799-5729
Mailing address
415 6TH STREET, ATTN: PHYSICIAN SERVICES, LEWISTON, ID 83501-2424
(208) 750-7462
(208) 750-7467
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
L2777
TX
2084N0400X
Neurology Physician
Primary
M-12101
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151672601
—
AR
05
—
151672601
—
TX
05
—
1881695534
—
ID
Enumeration date
08/03/2005
Last updated
12/26/2024
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