Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A18947 | CA |
NPI | 1033539762 |
---|---|
Provider Name | Thomas Joseph Mcgillis |
First Address | Ventura, CA 93003 |
Second Address | Ventura, CA 93003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 21/04/2014 |