Provider Demographics
NPI:1801828181
Name:BOWSTEAD, THOMAS TIFFAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:TIFFAN
Last Name:BOWSTEAD
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 1:901 CAMPUS DR
Mailing Address - Street 2:STE 308
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4900
Mailing Address - Country:US
Mailing Address - Phone:650-991-0600
Mailing Address - Fax:650-991-0306
Practice Address - Street 1:901 CAMPUS DR
Practice Address - Street 2:STE 308
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4900
Practice Address - Country:US
Practice Address - Phone:650-991-0600
Practice Address - Fax:650-991-0306
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35281207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35924Medicare UPIN