Provider Demographics
NPI:1326192816
Name:THOMAS, GREGORY W (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:116 CERRO ROMAULDO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1273
Mailing Address - Country:US
Mailing Address - Phone:805-544-6147
Mailing Address - Fax:805-756-5298
Practice Address - Street 1:1 GRAND AVE
Practice Address - Street 2:CALIFORNIA POLYTECHNIC STATE UNIVERSITY SAN LUIS OBISPO
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93407-0210
Practice Address - Country:US
Practice Address - Phone:805-756-1211
Practice Address - Fax:805-756-5298
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine