Provider Demographics
NPI:1932281334
Name:GUERRERO, THOMAS M (MD, PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-421-7004
Practice Address - Street 1:1410 S LA BRUCHERIE RD STE B
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9676
Practice Address - Country:US
Practice Address - Phone:760-339-5620
Practice Address - Fax:760-339-5621
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL53502085R0001X
MI43011062752085R0001X
CAA667562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932281334Medicaid
TX152172601Medicaid
MI1932281334Medicaid
H66466Medicare UPIN