Provider Demographics
NPI:1669465878
Name:ARNOLD, TAMMIE KAY (DO)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:KAY
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 STATION WAY UNIT 1633
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93421-5083
Mailing Address - Country:US
Mailing Address - Phone:805-202-8513
Mailing Address - Fax:805-270-4337
Practice Address - Street 1:160 STATION WAY UNIT 1633
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93421-5083
Practice Address - Country:US
Practice Address - Phone:805-202-8513
Practice Address - Fax:805-270-4337
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006235207R00000X
CA20A 10023207R00000X
CA20A10023208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10787925OtherCAQH PROVIDER NUMBER
OHP00413734OtherMEDICARE RAILROAD
OH2042800Medicaid
OH2042800Medicaid
OHG62757Medicare UPIN
CA10787925OtherCAQH PROVIDER NUMBER