Basic Information
| Provider Information | |||||||||
| NPI: | 1578630646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2757 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928590757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149732650 | ||||||||
| FaxNumber: | 7149732655 | ||||||||
| Practice Location | |||||||||
| Address1: | 10900 WARNER AVE | ||||||||
| Address2: | #101A | ||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927083846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148870150 | ||||||||
| FaxNumber: | 7146981270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 06/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A55827 | CA | N | Other Service Providers | Specialist | 207L00000X | A55827 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.