Provider Demographics
NPI:1407834146
Name:THOMAS, GREGORY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2865 ATLANTIC AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1740
Mailing Address - Country:US
Mailing Address - Phone:562-933-1820
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2013-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG49797207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G497970Medicaid
CA00G497970Medicaid
CAWG49797BMedicare PIN