Provider Demographics
NPI:1366530586
Name:DONCASTER, THOMAS (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DONCASTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0247
Mailing Address - Country:US
Mailing Address - Phone:423-784-0269
Mailing Address - Fax:
Practice Address - Street 1:475 N HIGHWAY 25 W
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1576
Practice Address - Country:US
Practice Address - Phone:606-549-2933
Practice Address - Fax:606-549-3036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001103207Q00000X
KY02454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64024540Medicaid
TN3304309Medicaid
TN3304309Medicaid
KY329101Medicare ID - Type Unspecified
TN3304308Medicare ID - Type Unspecified