Provider Demographics
NPI:1689673477
Name:MOORE, THOMAS HOLMES JR (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HOLMES
Last Name:MOORE
Suffix:JR
Gender:
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:15620 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-9617
Mailing Address - Country:US
Mailing Address - Phone:707-473-4531
Mailing Address - Fax:707-473-4559
Practice Address - Street 1:5300 SNYDER LN
Practice Address - Street 2:STE A
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2915
Practice Address - Country:US
Practice Address - Phone:707-585-8347
Practice Address - Fax:707-585-8056
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A45330Medicaid
CA080075198OtherRAILROAD MEDICARE
CA020A45330OtherBLUE SHIELD OF CALIFORNIA
CA020A45330Medicare ID - Type Unspecified
CA020A45330Medicaid