Healthcare Provider Details

I. General information

NPI: 1477558435
Provider Name (Legal Business Name): THOMAS J SPILLANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 TANK FARM ROAD SUITE C
SAN LUIS OBISPO CA
93401-7068
US

IV. Provider business mailing address

715 TANK FARM RD STE C
SAN LUIS OBISPO CA
93401-7068
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-5577
  • Fax: 805-595-3231
Mailing address:
  • Phone: 805-543-5577
  • Fax: 805-595-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG79734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: