Provider Demographics
NPI:1528167293
Name:THOMSON, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:THOMSON
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:475 PIONEER AVE
Practice Address - Street 2:#400
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4905
Practice Address - Country:US
Practice Address - Phone:530-406-5600
Practice Address - Fax:530-406-5626
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A699600Medicaid
00A699600Medicare ID - Type Unspecified
CA00A699600Medicaid
CA00A699601Medicare PIN