Provider Demographics
NPI:1649293150
Name:THOMAS, GEORGE P (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DUARTE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9278
Mailing Address - Country:US
Mailing Address - Phone:626-447-0782
Mailing Address - Fax:626-447-0795
Practice Address - Street 1:622 W DUARTE RD STE 302
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9278
Practice Address - Country:US
Practice Address - Phone:626-447-0782
Practice Address - Fax:626-447-0795
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35801207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A358011Medicaid
CAA35801Medicare ID - Type Unspecified
CA00A358011Medicaid