Provider Demographics
NPI:1871529883
Name:MCANALLY, THOMAS PAUL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAUL
Last Name:MCANALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 N MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DAMMERON VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84783-5072
Mailing Address - Country:US
Mailing Address - Phone:435-574-0091
Mailing Address - Fax:435-574-0466
Practice Address - Street 1:1501 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2815
Practice Address - Country:US
Practice Address - Phone:970-874-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24020207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD22611Medicare UPIN