Provider Demographics
NPI:1265596191
Name:GUYN, THOMAS C (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:GUYN
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 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-546-2180
Mailing Address - Fax:707-546-2188
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 300
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-546-2180
Practice Address - Fax:707-546-2188
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012487OtherPREFERRED ONE
507T7GUOtherBLUE CROSS BLUE SHIELD
CAP01315573OtherRR MEDICARE
596132OtherAMERICAN PPO
CAP01315573OtherRR MEDICARE
CAP01315573OtherRR MEDICARE
C04011Medicare UPIN
MN110009866Medicare ID - Type Unspecified