Healthcare Provider Details

I. General information

NPI: 1962648436
Provider Name (Legal Business Name): ANTHONY JOSEPH THOMAS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CENTER ST
TAFT CA
93268-3511
US

IV. Provider business mailing address

400 CENTER ST
TAFT CA
93268-3511
US

V. Phone/Fax

Practice location:
  • Phone: 661-763-3606
  • Fax: 661-765-6005
Mailing address:
  • Phone: 661-763-3606
  • Fax: 661-765-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG79817
License Number StateCA

VIII. Authorized Official

Name: ANTHONY JOSEPH THOMAS
Title or Position: OWNER
Credential: MD
Phone: 661-763-3606