Provider Demographics
NPI:1740201649
Name:GUFFY, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:GUFFY
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 1:2101 BEASER AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3632
Mailing Address - Country:US
Mailing Address - Phone:715-682-0482
Mailing Address - Fax:715-682-4297
Practice Address - Street 1:2101 BEASER AVE STE 6
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3632
Practice Address - Country:US
Practice Address - Phone:715-682-0482
Practice Address - Fax:715-682-4297
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34834207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31978900Medicaid
E86552Medicare UPIN
04081Medicare ID - Type Unspecified