MEDICARE: COLIN MATTHEW THOMAS MD, MPH

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	207R00000X	Internal Medicine Physician	G78265	CA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	G78265	CA

General Provider Information

NPI Number	:	1700849502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN MATTHEW THOMAS MD, MPH

Provider Business Mailing Address
First Line	:	VA SAN DIEGO HEALTHCARE
Second Line	:	MAIL CODE 111N
City	:	SAN DIEGO
State	:	CA
Zip	:	92161-0001
Country	:	US
Telephone Number	:	858-552-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	VA SAN DIEGO HEALTHCARE
Second Line	:	MAIL CODE 111N
City	:	SAN DIEGO
State	:	CA
Zip	:	92161-0001
Country	:	US
Telephone Number	:	858-552-8585
Fax Number	:

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	02/23/2011

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