Provider Demographics
NPI:1164488342
Name:MONFORE, THOMAS EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:MONFORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:470 GREENFIELD AVE
Mailing Address - Street 2:SUITE 37
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3513
Mailing Address - Country:US
Mailing Address - Phone:559-585-2100
Mailing Address - Fax:559-585-2150
Practice Address - Street 1:470 GREENFIELD AVE
Practice Address - Street 2:SUITE 37
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3513
Practice Address - Country:US
Practice Address - Phone:559-585-2100
Practice Address - Fax:559-585-2150
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA19170208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-1705072OtherTAX ID
CAZZZ78388ZMedicare ID - Type Unspecified
CAA21634Medicare UPIN