Provider Demographics
NPI:1164597472
Name:FIRNBERG, THOMAS LEWIS II (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEWIS
Last Name:FIRNBERG
Suffix:II
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 1:400 N PARK AVE
Mailing Address - Street 2:UNIT #10-B
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8850
Mailing Address - Country:US
Mailing Address - Phone:951-533-9993
Mailing Address - Fax:970-368-6509
Practice Address - Street 1:1212 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1552
Practice Address - Country:US
Practice Address - Phone:209-468-8842
Practice Address - Fax:209-953-1041
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0402182084P0800X
IDM-108772084P0800X
CO486352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA104706Medicare PIN