Provider Demographics
NPI:1902844145
Name:VINER, THOMAS FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FREDERIC
Last Name:VINER
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 1:2615 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9565
Mailing Address - Country:US
Mailing Address - Phone:319-351-5680
Mailing Address - Fax:319-351-8980
Practice Address - Street 1:2615 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9565
Practice Address - Country:US
Practice Address - Phone:319-351-5680
Practice Address - Fax:319-351-8980
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19539207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15812OtherWELLMARK
IA0158121Medicaid
040004101OtherRAILROAD MEDICARE
IA0423459Medicaid
IA0423459Medicaid
040004101OtherRAILROAD MEDICARE
IAA01267Medicare UPIN