Provider Demographics
NPI:1578630646
Name:THOMAS, JOHN MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-0757
Mailing Address - Country:US
Mailing Address - Phone:714-973-2650
Mailing Address - Fax:714-973-2655
Practice Address - Street 1:10900 WARNER AVE
Practice Address - Street 2:#101A
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:714-887-0150
Practice Address - Fax:714-698-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA55827174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72774Medicare UPIN