Provider Demographics
NPI:1265543482
Name:PENDLETON, THOMAS CARL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CARL
Last Name:PENDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:985 9TH AVE SW
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4500
Mailing Address - Country:US
Mailing Address - Phone:205-481-7470
Mailing Address - Fax:205-481-7469
Practice Address - Street 1:985 9TH AVE SW
Practice Address - Street 2:SUITE 406
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4500
Practice Address - Country:US
Practice Address - Phone:205-481-7470
Practice Address - Fax:205-481-7469
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL13310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51080542OtherBLUE CROSS/BLUE SHIELD
AL000080542Medicaid
ALE14406Medicare UPIN
AL000080542Medicaid