Provider Demographics
NPI:1346288321
Name:ATLAS, THOMAS L (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:ATLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13422 NEWPORT AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3746
Mailing Address - Country:US
Mailing Address - Phone:714-665-6900
Mailing Address - Fax:714-665-6904
Practice Address - Street 1:13422 NEWPORT AVE
Practice Address - Street 2:SUITE I
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3746
Practice Address - Country:US
Practice Address - Phone:714-665-6900
Practice Address - Fax:714-665-6904
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG745352471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002082232Medicaid
CA00G745350OtherBLUE SHIELD GROUP NUMBER
CA00G745350Medicaid
NV002082232Medicaid
CA00G745350Medicaid