Provider Demographics
NPI:1205881398
Name:THOMAS, CARLTON WAYNE JR (MD)
Entity type:Individual
Prefix:
First Name:CARLTON
Middle Name:WAYNE
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:35900 BOB HOPE DR
Mailing Address - Street 2:STE 275
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1766
Mailing Address - Country:US
Mailing Address - Phone:760-321-2500
Mailing Address - Fax:760-321-5720
Practice Address - Street 1:292 EUCLID AVE STE 115
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3629
Practice Address - Country:US
Practice Address - Phone:619-266-3332
Practice Address - Fax:619-266-6000
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA00A88112207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A881121Medicare PIN