Provider Demographics
NPI:1588785125
Name:ERNEST M. THOMAS,JR.,MD.INC.
Entity type:Organization
Organization Name:ERNEST M. THOMAS,JR.,MD.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-378-2552
Mailing Address - Street 1:360 DARDANELLI LN
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1421
Mailing Address - Country:US
Mailing Address - Phone:408-378-2552
Mailing Address - Fax:408-378-8317
Practice Address - Street 1:360 DARDANELLI LN
Practice Address - Street 2:SUITE 1A
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1421
Practice Address - Country:US
Practice Address - Phone:408-378-2552
Practice Address - Fax:408-378-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23340207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA011901064OtherMEDICARE RAILROAD
CA011901064OtherMEDICARE RAILROAD
CAA47299Medicare UPIN