Provider Demographics
NPI:1104879287
Name:THOMAS, DAVID EARL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EARL
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 1:8772 CUYAMACA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4218
Mailing Address - Country:US
Mailing Address - Phone:619-258-6731
Mailing Address - Fax:619-448-8586
Practice Address - Street 1:8772 CUYAMACA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4218
Practice Address - Country:US
Practice Address - Phone:619-258-6731
Practice Address - Fax:619-448-8586
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC506642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C506640Medicare ID - Type Unspecified
C28355Medicare UPIN