Provider Demographics
NPI:1154337095
Name:THOMAS, ROBERT M JR (M D,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:M D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3002
Mailing Address - Country:US
Mailing Address - Phone:800-765-2737
Mailing Address - Fax:619-692-0229
Practice Address - Street 1:3939 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3002
Practice Address - Country:US
Practice Address - Phone:800-765-2737
Practice Address - Fax:619-692-0229
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31483207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C314830Medicaid
CAW13959Medicare ID - Type UnspecifiedGROUP MEDICARE
CA00C314830Medicaid
CA4696520001Medicare NSC
CAA34585Medicare UPIN
CAC31483Medicare ID - Type Unspecified