Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01064795A | IN |
N | 207X00000X | Orthopaedic Surgeon | A88661 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | A88661 | CA |
NPI | 1073504320 |
---|---|
Provider Name | Mr. Thomas James Mcdonald |
First Address | Sonora, CA 95370 |
Second Address | Sonora, CA 95370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 10/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000585039 | ANTHEM TRADITIONAL ACCESS & PREFERRED (01) | IN |
200917390 | (05) | IN |
4405104 | CIGNA (01) | IN |
9362175 | AETNA (01) | IN |
P00703265 | RR MEDICARE (01) | IN |
RES000 | (02) | CA |