Provider Demographics
NPI:1063404606
Name:THOMAS, WALTER ALAIN (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ALAIN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3444 KEARNY VILLA RD
Mailing Address - Street 2:STE 303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1959
Mailing Address - Country:US
Mailing Address - Phone:858-616-6400
Mailing Address - Fax:858-616-6936
Practice Address - Street 1:3444 KEARNY VILLA RD
Practice Address - Street 2:STE 303
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1959
Practice Address - Country:US
Practice Address - Phone:858-616-6400
Practice Address - Fax:858-616-6936
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA67913207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679130Medicaid
CAA67913OtherSTATE LICENSE
CAA67913OtherSTATE LICENSE
CA00A679130Medicaid