Provider Demographics
NPI:1053320234
Name:POIRIER, TOMMY J (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:J
Last Name:POIRIER
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-5336
Practice Address - Fax:916-733-5385
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21635207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11720OtherFIRST HEALTH
CAG21635OtherBLUE CROSS
CA013520OtherHEALTH NET
CA1090747OtherGREAT WEST
CA259062OtherUNITED HEALTHCARE
CA90019023OtherPACIFICARE
CA00G216350Medicaid
CA4054884OtherAETNA
CA15147OtherINTERPLAN
CAMCMG157200OtherWESTERN HEALTH ADVANTAGE
CA000001230694OtherPHCS
CA0006685OtherCIGNA
CA15147OtherINTERPLAN
CA00G216350Medicaid