Healthcare Provider Details

I. General information

NPI: 1689747594
Provider Name (Legal Business Name): ROBERT A ST. THOMAS M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W ORANGE AVE
ANAHEIM CA
92804-3156
US

IV. Provider business mailing address

PO BOX 2757
ORANGE CA
92859-0757
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-3000
  • Fax:
Mailing address:
  • Phone: 714-973-2650
  • Fax: 714-973-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC40543
License Number StateCA

VIII. Authorized Official

Name: ROBERT A ST THOMAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-973-2650