Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 15418R | LA |
NPI | 1043306202 |
---|---|
Provider Name | Dr. Jason S Thomas |
First Address | Patton, CA 92369 |
Second Address | Patton, CA 92369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 12/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I27255 | (02) | LA |