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NPI Code Detail

MEDICARE: DR. JOHN HOLLISTER THACHER M.D.

MEDICARE: DR. JOHN HOLLISTER THACHER 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
1207ND0900XDermatopathology PhysicianG18881CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ71761ZOTHERCABLUE SHIELD

General Provider Information

NPI Number : 1205962032
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN HOLLISTER THACHER M.D.
Provider Business Mailing Address
First Line : 115 PIRIE RD STE F
Second Line :
City : OJAI
State : CA
Zip : 93023-3100
Country : US
Telephone Number : 805-648-6969
Fax Number :
Provider Business Practice Location Address
First Line : 115 PIRIE RD STE F
Second Line :
City : OJAI
State : CA
Zip : 93023-3100
Country : US
Telephone Number : 805-648-6969
Fax Number : 805-648-3762
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 03/06/2025

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