Provider Demographics
NPI:1336146026
Name:THOMAS K. MAYEDA, M.D., PC
Entity Type:Organization
Organization Name:THOMAS K. MAYEDA, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAYEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-989-1284
Mailing Address - Street 1:7373 W JEFFERSON AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2038
Mailing Address - Country:US
Mailing Address - Phone:303-989-1284
Mailing Address - Fax:303-988-6229
Practice Address - Street 1:7373 W JEFFERSON AVE
Practice Address - Street 2:STE 103
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2038
Practice Address - Country:US
Practice Address - Phone:303-989-1284
Practice Address - Fax:303-988-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25108221Medicaid
CO25108221Medicaid