Healthcare Provider Details

I. General information

NPI: 1700818168
Provider Name (Legal Business Name): THOMAS B MCNEMAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W GRANT LINE RD SUITE 250
TRACY CA
95377-7330
US

IV. Provider business mailing address

2160 W GRANT LINE RD SUITE 250
TRACY CA
95377-7330
US

V. Phone/Fax

Practice location:
  • Phone: 209-834-0626
  • Fax: 209-834-1814
Mailing address:
  • Phone: 209-834-0626
  • Fax: 209-834-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG85212
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberG85212
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG85212
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS B MCNEMAR
Title or Position: OWNER
Credential: M.D.
Phone: 209-834-0626