1811962145 NPI number — DR. THOMAS T STREETER M.D.

Table of content: DR. THOMAS T STREETER M.D. (NPI 1811962145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811962145 NPI number — DR. THOMAS T STREETER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STREETER
Provider First Name:
THOMAS
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811962145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95241-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-334-1800
Provider Business Mailing Address Fax Number:
209-334-1430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2509 W MARCH LN
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95207-8252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-957-1000
Provider Business Practice Location Address Fax Number:
209-957-1001
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A23450 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: A23450 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A234500 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386636165 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com