Provider Demographics
NPI:1417946096
Name:HILDRETH, THOMAS ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARTHUR
Last Name:HILDRETH
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 1:915 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-4744
Mailing Address - Country:US
Mailing Address - Phone:707-252-8928
Mailing Address - Fax:707-224-5220
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 213
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-224-7944
Practice Address - Fax:707-224-5220
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38117208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C381170Medicaid
0315750001OtherDMERC
0315750001OtherDMERC