Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | G71958 | CA |
NPI | 1306886916 |
---|---|
Provider Name | Thomas James O'laughlin |
First Address | Clovis, CA 93612-0861 |
Second Address | Clovis, CA 93612-0861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G719580 | (05) | CA |
F66546 | (02) |