Provider Demographics
NPI:1306887435
Name:LOBUE, THOMAS DAVID (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DAVID
Last Name:LOBUE
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 1:40700 CALIFORNIA OAKS RD
Mailing Address - Street 2:#106
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5789
Mailing Address - Country:US
Mailing Address - Phone:951-696-1135
Mailing Address - Fax:951-304-9068
Practice Address - Street 1:40700 CALIFORNIA OAKS RD
Practice Address - Street 2:#106
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-696-1135
Practice Address - Fax:951-304-9068
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG598470207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B58082Medicare UPIN
CA0468620001Medicare NSC