=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972091429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAXWELL STEVEN THOMAS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2018
-----------------------------------------------------
Last Update Date | 11/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8737 BEVERLY BLVD SUITE 203
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-1840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-525-1118
-----------------------------------------------------
Fax | 818-303-1306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SYNERGY HEMATOLOGY ONCOLOGY MEDICAL ASSOCIATES INC P.O. BOX 48107
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-0107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-525-1118
-----------------------------------------------------
Fax | 818-303-1306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A164898
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------