Healthcare Provider Details

I. General information

NPI: 1679779508
Provider Name (Legal Business Name): CHARLES SCOTT THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

6311 MONTEREY RD #209
LOS ANGELES CA
90042-4391
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-7556
  • Fax:
Mailing address:
  • Phone: 323-259-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA98973
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA98973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: