Provider Demographics
NPI:1770624538
Name:THOMAS M WEED MD INC
Entity type:Organization
Organization Name:THOMAS M WEED MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-384-2353
Mailing Address - Street 1:436 E YOSEMITE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8489
Mailing Address - Country:US
Mailing Address - Phone:209-384-2353
Mailing Address - Fax:209-388-0629
Practice Address - Street 1:436 E YOSEMITE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8489
Practice Address - Country:US
Practice Address - Phone:209-384-2353
Practice Address - Fax:209-388-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G394750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180043023OtherRAILROAD
CA0440710001Medicare NSC
CA180043023OtherRAILROAD