Provider Demographics
NPI:1801467543
Name:THOMAS, ANDREW (DPM)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4343 MARKET ST STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3567
Mailing Address - Country:US
Mailing Address - Phone:909-233-7823
Mailing Address - Fax:909-295-6075
Practice Address - Street 1:4343 MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3567
Practice Address - Country:US
Practice Address - Phone:909-233-7823
Practice Address - Fax:909-295-6075
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6009213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist