Provider Demographics
NPI:1710567979
Name:THOMAS, ALEXANDER ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ANTHONY
Last Name:THOMAS
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 1:12683 NINEBARK ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-1209
Mailing Address - Country:US
Mailing Address - Phone:415-314-0677
Mailing Address - Fax:
Practice Address - Street 1:12683 NINEBARK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-1209
Practice Address - Country:US
Practice Address - Phone:415-314-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17105679792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry