Provider Demographics
NPI:1578545794
Name:MCINTYRE, THOMAS MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 STATES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1405
Mailing Address - Country:US
Mailing Address - Phone:415-626-5255
Mailing Address - Fax:415-431-9703
Practice Address - Street 1:285 STATES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1405
Practice Address - Country:US
Practice Address - Phone:415-626-5255
Practice Address - Fax:415-431-9703
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA817367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered