Provider Demographics
NPI:1487831400
Name:PAUL T TOM DPM
Entity Type:Organization
Organization Name:PAUL T TOM DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:831-422-6711
Mailing Address - Street 1:515 ALAMEDA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4024
Mailing Address - Country:US
Mailing Address - Phone:831-422-6711
Mailing Address - Fax:831-783-1862
Practice Address - Street 1:515 ALAMEDA AVE STE D
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4024
Practice Address - Country:US
Practice Address - Phone:831-422-6711
Practice Address - Fax:831-783-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3531213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6020540001Medicare NSC