Provider Demographics
NPI:1407851884
Name:MCGUIRE, THOMAS WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:MCGUIRE
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 1:2560 BUSINESS PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-6503
Mailing Address - Country:US
Mailing Address - Phone:423-472-5401
Mailing Address - Fax:423-479-3060
Practice Address - Street 1:2560 BUSINESS PARK DR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-6503
Practice Address - Country:US
Practice Address - Phone:423-472-5401
Practice Address - Fax:423-479-3060
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000023562207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30751811OtherMEDICARE ID - PTAN
TN3075188Medicaid
TNE92027Medicare UPIN