Provider Demographics
NPI:1467566596
Name:THOMAS, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
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 1:408 E 3RD ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2854
Mailing Address - Country:US
Mailing Address - Phone:760-357-7700
Mailing Address - Fax:760-357-7709
Practice Address - Street 1:408 E 3RD ST
Practice Address - Street 2:SUITE F
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2854
Practice Address - Country:US
Practice Address - Phone:760-357-7700
Practice Address - Fax:760-357-7709
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A395831Medicaid
CA00A395831Medicaid
CAA39583Medicare ID - Type Unspecified