=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356610968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM HUGH BEVAN-THOMAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2011
-----------------------------------------------------
Last Update Date | 12/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1461 ARBOR LN
-----------------------------------------------------
City | ALAMO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94507-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-945-6695
-----------------------------------------------------
Fax | 925-945-8483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1461 ARBOR LN
-----------------------------------------------------
City | ALAMO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94507-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-945-6695
-----------------------------------------------------
Fax | 925-945-8483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | AFE22622
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------