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NPI Code Detail

MEDICARE: DR. THOMAS JOSEPH JANTOS MD

MEDICARE: DR. THOMAS JOSEPH JANTOS MD
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
1207P00000XEmergency Medicine Physician9173NV
2207P00000XEmergency Medicine PhysicianA62096CA

General Provider Information

NPI Number : 1639176415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS JOSEPH JANTOS MD
Provider Business Mailing Address
First Line : 1111 EMERALD BAY RD
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-6207
Country : US
Telephone Number : 530-543-5979
Fax Number : 530-541-8723
Provider Business Practice Location Address
First Line : 2170 SOUTH AVE
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7026
Country : US
Telephone Number : 530-541-3420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 03/17/2018

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Directions to “ DR. THOMAS JOSEPH JANTOS MD” Practice Location

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