Healthcare Provider Details

I. General information

NPI: 1821142647
Provider Name (Legal Business Name): ALAN V THOMAS PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 TRUXTUN AVE
BAKERSFIELD CA
93309-0633
US

IV. Provider business mailing address

6501 TRUXTUN AVE
BAKERSFIELD CA
93309-0633
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-2206
  • Fax: 661-327-7027
Mailing address:
  • Phone: 661-322-2206
  • Fax: 661-327-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: