Healthcare Provider Details

I. General information

NPI: 1386038164
Provider Name (Legal Business Name): CHRISTOPHER M THOMAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

IV. Provider business mailing address

147 N. BRENT STREET
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 360-814-2663
  • Fax: 360-814-6953
Mailing address:
  • Phone: 805-652-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOP61044324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: