Provider Demographics
NPI:1558329920
Name:KRENEK, THOMAS F IV (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:KRENEK
Suffix:IV
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:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:95524-0692
Mailing Address - Country:US
Mailing Address - Phone:707-269-9550
Mailing Address - Fax:
Practice Address - Street 1:2200 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3215
Practice Address - Country:US
Practice Address - Phone:707-269-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG437972084N0400X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G437970Medicaid
130004937OtherRAILROAD MEDICARE
00G437970Medicare ID - Type Unspecified
130004937OtherRAILROAD MEDICARE