Provider Demographics
NPI:1811019938
Name:TOM MEASLES MD PROF CORP
Entity Type:Organization
Organization Name:TOM MEASLES MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MEASLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-370-5444
Mailing Address - Street 1:2190 LYNN RD
Mailing Address - Street 2:STE 320
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1980
Mailing Address - Country:US
Mailing Address - Phone:805-370-5444
Mailing Address - Fax:805-370-5515
Practice Address - Street 1:2190 LYNN RD
Practice Address - Street 2:STE 320
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1980
Practice Address - Country:US
Practice Address - Phone:805-370-5444
Practice Address - Fax:805-370-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67464208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17930Medicare ID - Type UnspecifiedGROUP ID