Provider Demographics
NPI:1790080281
Name:DR THAKER MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR THAKER MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:D
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-467-1001
Mailing Address - Street 1:415 E HARDING WAY
Mailing Address - Street 2:SUITE I
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6118
Mailing Address - Country:US
Mailing Address - Phone:209-467-1001
Mailing Address - Fax:209-467-1005
Practice Address - Street 1:415 E HARDING WAY
Practice Address - Street 2:SUITE I
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6118
Practice Address - Country:US
Practice Address - Phone:209-467-1001
Practice Address - Fax:209-467-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52146207V00000X
CAC52147207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty