Provider Demographics
NPI:1982608683
Name:MCNEMAR, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:MCNEMAR
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 1:2160 W GRANT LINE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7330
Mailing Address - Country:US
Mailing Address - Phone:209-834-0626
Mailing Address - Fax:209-834-1814
Practice Address - Street 1:2160 W GRANT LINE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7330
Practice Address - Country:US
Practice Address - Phone:209-834-0626
Practice Address - Fax:209-834-1814
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-11-05
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAG852122082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA651205718OtherTAX ID NUMBER
CA651205718OtherTAX ID NUMBER