Provider Demographics
NPI:1306886916
Name:O'LAUGHLIN, THOMAS JAMES (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:O'LAUGHLIN
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 1:255 W BULLARD AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0861
Mailing Address - Country:US
Mailing Address - Phone:559-498-0268
Mailing Address - Fax:559-498-0269
Practice Address - Street 1:255 W BULLARD AVE STE 112
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0861
Practice Address - Country:US
Practice Address - Phone:559-498-0268
Practice Address - Fax:559-498-0269
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG719582081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G719580Medicaid
F66546Medicare UPIN
CA00G719580Medicaid