Healthcare Provider Details

I. General information

NPI: 1205881398
Provider Name (Legal Business Name): CARLTON WAYNE THOMAS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 EUCLID AVE STE 115
SAN DIEGO CA
92114-3629
US

IV. Provider business mailing address

35900 BOB HOPE DR STE 275
RANCHO MIRAGE CA
92270-1766
US

V. Phone/Fax

Practice location:
  • Phone: 619-266-3332
  • Fax: 619-266-6000
Mailing address:
  • Phone: 760-321-2500
  • Fax: 760-321-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number00A88112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: