Provider Demographics
NPI:1770535072
Name:THOMAS, JEFFREY E (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
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 1:2500 MOWRY AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1605
Mailing Address - Country:US
Mailing Address - Phone:510-818-1160
Mailing Address - Fax:510-818-1195
Practice Address - Street 1:2500 MOWRY AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1605
Practice Address - Country:US
Practice Address - Phone:510-818-1160
Practice Address - Fax:510-818-1195
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67705207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67705OtherCA STATE MEDICAL LICENSE
00G677050Medicare ID - Type Unspecified
G27912Medicare UPIN