Healthcare Provider Details

I. General information

NPI: 1487607487
Provider Name (Legal Business Name): THOMAS LENZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
FAIRFIELD CA
94535-1809
US

IV. Provider business mailing address

1108 WHISPERING PINES RD
CLAYTON CA
94517-9728
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3826
  • Fax:
Mailing address:
  • Phone: 925-672-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG28262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: