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General NPI Number Information
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NPI Number | 1396199378
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Entity Type | Individual
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Provider Name | ROBERT THAYER DO
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Gender | Male
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 1300 N VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-6098
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Country | US
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Telephone | 323-913-4387
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Fax | 323-953-6338
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Provider Business Mailing Address
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Address Line | 418 S ELECTRIC AVE APT A
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City | ALHAMBRA
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State | CA
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Zip | 91803-1656
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Country | US
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Telephone | 858-539-3286
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Fax | 602-344-1185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A17097
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License Number State | CA
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