Provider Demographics
NPI:1770595514
Name:ATWOOD, THOMAS CLYDE (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CLYDE
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 9TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-3089
Mailing Address - Country:US
Mailing Address - Phone:970-353-5800
Mailing Address - Fax:970-353-5854
Practice Address - Street 1:2122 9TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3089
Practice Address - Country:US
Practice Address - Phone:970-353-5800
Practice Address - Fax:970-353-5854
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO457213ES0131X
WY102213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113584800Medicaid
CO09628223Medicaid
WY9154Medicare ID - Type Unspecified
CO09628223Medicaid
WY113584800Medicaid