Provider Demographics
NPI:1609966423
Name:KILBRIDGE, THOMAS MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARTIN
Last Name:KILBRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:731 JACARANDA CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-6556
Mailing Address - Country:US
Mailing Address - Phone:650-347-0947
Mailing Address - Fax:650-347-0947
Practice Address - Street 1:4021 S 700 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2192
Practice Address - Country:US
Practice Address - Phone:800-732-7176
Practice Address - Fax:801-284-6753
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC33702207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF08498Medicare UPIN