Provider Demographics
NPI:1164769535
Name:GREGORY S THOMAS MD MPH CORPORATION
Entity Type:Organization
Organization Name:GREGORY S THOMAS MD MPH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:949-310-0246
Mailing Address - Street 1:32582 BALEARIC RD
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3613
Mailing Address - Country:US
Mailing Address - Phone:949-310-0246
Mailing Address - Fax:562-933-1819
Practice Address - Street 1:2865 ATLANTIC AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1740
Practice Address - Country:US
Practice Address - Phone:562-933-1820
Practice Address - Fax:562-933-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G49797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty