Healthcare Provider Details

I. General information

NPI: 1326212499
Provider Name (Legal Business Name): ANTHONY JOSEPH THOMAS M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 19TH ST
BAKERSFIELD CA
93301-3608
US

IV. Provider business mailing address

PO BOX 21831
BAKERSFIELD CA
93390-1831
US

V. Phone/Fax

Practice location:
  • Phone: 661-631-9455
  • Fax: 661-631-9454
Mailing address:
  • Phone: 661-631-9455
  • Fax: 661-631-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG79817
License Number StateCA

VIII. Authorized Official

Name: ANTHONY THOMAS
Title or Position: OWNER
Credential: MD
Phone: 661-631-9455