Provider Demographics
NPI:1073504320
Name:MCDONALD, THOMAS JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAMES
Last Name:MCDONALD
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 1:680 GUZZI LANE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-532-0126
Mailing Address - Fax:209-532-2950
Practice Address - Street 1:680 GUZZI LANE
Practice Address - Street 2:SUITE 105
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-532-0126
Practice Address - Fax:209-532-2950
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88661207X00000X, 207XS0106X
IN01064795A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4405104OtherCIGNA
IN200917390Medicaid
IN000000585039OtherANTHEM TRADITIONAL ACCESS & PREFERRED
IN9362175OtherAETNA
INP00703265OtherRR MEDICARE
IN9362175OtherAETNA
IN000000585039OtherANTHEM TRADITIONAL ACCESS & PREFERRED
IN200917390Medicaid