Provider Demographics
NPI:1952309908
Name:MUSTOE, THOMAS ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLEN
Last Name:MUSTOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:230 SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3901
Mailing Address - Country:US
Mailing Address - Phone:831-758-2100
Mailing Address - Fax:831-758-1565
Practice Address - Street 1:230 SAN JOSE ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3901
Practice Address - Country:US
Practice Address - Phone:831-758-2100
Practice Address - Fax:831-758-1565
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43634207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110126163OtherRAILROAD MEDICARE SVMH READING
CAA00043634OtherBLUE CROSS
CA110074639OtherRAILROAD MEDICARE CCC
CA00A436340Medicaid
CA00A436342Medicare PIN
CAA00043634OtherBLUE CROSS
CAA29717Medicare UPIN