Healthcare Provider Details

I. General information

NPI: 1679563159
Provider Name (Legal Business Name): FRED B TOMLINSON MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MOUNT HERMON RD # A
SCOTTS VALLEY CA
95066-4086
US

IV. Provider business mailing address

223 MOUNT HERMON RD # A
SCOTTS VALLEY CA
95066-4086
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-1000
  • Fax: 831-462-9519
Mailing address:
  • Phone: 831-462-1000
  • Fax: 831-462-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG8048
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG80480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: