Provider Demographics
NPI:1043381395
Name:THOMAS, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 ELUSION CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-9580
Mailing Address - Country:US
Mailing Address - Phone:530-243-1559
Mailing Address - Fax:530-244-6547
Practice Address - Street 1:8925 ELUSION CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-9580
Practice Address - Country:US
Practice Address - Phone:530-243-1559
Practice Address - Fax:530-244-6547
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67068207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G670680Medicare ID - Type UnspecifiedMEDICARE ID#