Provider Demographics
NPI:1447730049
Name:THOMAS, DANNY L
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 8TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1656
Mailing Address - Country:US
Mailing Address - Phone:618-524-3653
Mailing Address - Fax:618-524-4769
Practice Address - Street 1:306 W 8TH ST APT D
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1656
Practice Address - Country:US
Practice Address - Phone:618-524-3653
Practice Address - Fax:618-524-4769
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000735324146L00000X, 207PE0004X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services