Provider Demographics
NPI:1205962032
Name:THACHER, JOHN HOLLISTER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOLLISTER
Last Name:THACHER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PIRIE RD STE F
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3100
Mailing Address - Country:US
Mailing Address - Phone:805-648-6969
Mailing Address - Fax:
Practice Address - Street 1:115 PIRIE RD STE F
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3100
Practice Address - Country:US
Practice Address - Phone:805-648-6969
Practice Address - Fax:805-648-3762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18881207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71761ZOtherBLUE SHIELD
CAA40452Medicare UPIN
CAW203Medicare ID - Type Unspecified