Healthcare Provider Details

I. General information

NPI: 1992371074
Provider Name (Legal Business Name): ANDREW J THOMAS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MARGARET LN STE B1
GRASS VALLEY CA
95945-5268
US

IV. Provider business mailing address

123 MARGARET LN STE C1
GRASS VALLEY CA
95945-5268
US

V. Phone/Fax

Practice location:
  • Phone: 530-410-0368
  • Fax: 530-410-0864
Mailing address:
  • Phone: 530-410-0368
  • Fax: 530-410-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW J THOMAS
Title or Position: OWNER
Credential: MD
Phone: 530-410-0368