MEDICARE: CARLTON WAYNE THOMAS JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	00A88112	CA

General Provider Information

NPI Number	:	1205881398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLTON WAYNE THOMAS JR. M.D.

Provider Business Mailing Address
First Line	:	35900 BOB HOPE DR
Second Line	:	STE 275
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-1766
Country	:	US
Telephone Number	:	760-321-2500
Fax Number	:	760-321-5720

Provider Business Practice Location Address
First Line	:	292 EUCLID AVE STE 115
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-3629
Country	:	US
Telephone Number	:	619-266-3332
Fax Number	:	619-266-6000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	12/22/2020

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