Healthcare Provider Details

I. General information

NPI: 1588785125
Provider Name (Legal Business Name): ERNEST M. THOMAS,JR.,MD.INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DARDANELLI LN SUITE 1A
LOS GATOS CA
95032-1421
US

IV. Provider business mailing address

360 DARDANELLI LN SUITE 1A
LOS GATOS CA
95032-1421
US

V. Phone/Fax

Practice location:
  • Phone: 408-378-2552
  • Fax: 408-378-8317
Mailing address:
  • Phone: 408-378-2552
  • Fax: 408-378-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC23340
License Number StateCA

VIII. Authorized Official

Name: DR. ERNEST M THOMAS
Title or Position: PRESIDENT
Credential: MD.
Phone: 408-378-2552