Provider Demographics
NPI:1104818491
Name:THERMOS, ALEXANDER (DO, DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:THERMOS
Suffix:
Gender:M
Credentials:DO, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COLUMBIA
Mailing Address - Street 2:STE A
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4101
Mailing Address - Country:US
Mailing Address - Phone:888-564-2081
Mailing Address - Fax:949-429-0623
Practice Address - Street 1:125 COLUMBIA
Practice Address - Street 2:STE A
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4101
Practice Address - Country:US
Practice Address - Phone:888-564-2081
Practice Address - Fax:949-429-0623
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38341207Q00000X
CA20A11028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34170731Medicaid
CO34170731Medicaid
COC809532Medicare PIN