Healthcare Provider Details

I. General information

NPI: 1528167293
Provider Name (Legal Business Name): JOHN B THOMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 PIONEER AVE #400
WOODLAND CA
95776-4905
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 530-406-5600
  • Fax: 530-406-5626
Mailing address:
  • Phone: 855-771-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: