Provider Demographics
NPI:1609873306
Name:MAYEDA, THOMAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:MAYEDA
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 1:7373 W JEFFERSON AVE
Mailing Address - Street 2:#103
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2038
Mailing Address - Country:US
Mailing Address - Phone:303-989-1284
Mailing Address - Fax:303-988-6229
Practice Address - Street 1:7373 W JEFFERSON AVE
Practice Address - Street 2:#103
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2038
Practice Address - Country:US
Practice Address - Phone:303-989-1284
Practice Address - Fax:303-988-6229
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66163OtherBLUE CROSS/BLUE SHIELD
CO012-140-48Medicaid
COC488758Medicare PIN
CO826013677Medicare PIN
CO012-140-48Medicaid