Provider Demographics
NPI:1295998730
Name:PETE THOMAS DPM PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PETE THOMAS DPM PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-835-9147
Mailing Address - Street 1:1535 E. 17TH ST.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8532
Mailing Address - Country:US
Mailing Address - Phone:714-834-9710
Mailing Address - Fax:714-834-9718
Practice Address - Street 1:1535 E. 17TH ST.
Practice Address - Street 2:SUITE 107
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8532
Practice Address - Country:US
Practice Address - Phone:714-834-9710
Practice Address - Fax:714-834-9718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty