Healthcare Provider Details

I. General information

NPI: 1306886916
Provider Name (Legal Business Name): THOMAS JAMES O'LAUGHLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE STE 112
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

255 W BULLARD AVE STE 112
CLOVIS CA
93612-0861
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-0268
  • Fax: 559-498-0269
Mailing address:
  • Phone: 559-498-0268
  • Fax: 559-498-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG71958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: