Provider Demographics
NPI:1477558435
Name:SPILLANE, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:SPILLANE
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 1:715 TANK FARM RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7068
Mailing Address - Country:US
Mailing Address - Phone:805-543-5577
Mailing Address - Fax:805-595-3231
Practice Address - Street 1:715 TANK FARM ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7068
Practice Address - Country:US
Practice Address - Phone:805-543-5577
Practice Address - Fax:805-595-3231
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79734207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S113351OtherINTEGRATED HEALTH PLAN PI
CA00G797340Medicaid
CA00G797340OtherBLUE SHIELD PIN
CA1018OtherCMSP PIN
CACA164416OtherMEDICARE ID
CAG58058Medicare UPIN
830007918Medicare PIN