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General NPI Number Information
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NPI Number | 1790080281
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Entity Type | Organization
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Legal Business Name | DR THAKER MD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 415 E HARDING WAY SUITE I
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City | STOCKTON
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State | CA
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Zip | 95204-6118
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Country | US
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Telephone | 209-467-1001
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Fax | 209-467-1005
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Provider Business Mailing Address
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Address Line | 415 E HARDING WAY SUITE I
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City | STOCKTON
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State | CA
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Zip | 95204-6118
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Country | US
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Telephone | 209-467-1001
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Fax | 209-467-1005
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PANKAJ D THAKER
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Credential | MD
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Telephone | 209-467-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C52146
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C52147
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License Number State | CA
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