Provider Demographics
NPI:1013989540
Name:PAUKERT, THOMAS T (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:T
Last Name:PAUKERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3443 VILLA LN
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6417
Mailing Address - Country:US
Mailing Address - Phone:707-252-8407
Mailing Address - Fax:707-252-8335
Practice Address - Street 1:3443 VILLA LN
Practice Address - Street 2:SUITE 6
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6417
Practice Address - Country:US
Practice Address - Phone:707-252-8407
Practice Address - Fax:707-252-8335
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG36333207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G363330Medicaid
CA1013989540OtherNPI
CA00G363331Medicare ID - Type UnspecifiedMEDICARE NUMBER
CAA46651Medicare UPIN