Healthcare Provider Details

I. General information

NPI: 1578182812
Provider Name (Legal Business Name): CALEB PAUL THOMAS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 BRIDGEPORT WAY W STE 308
UNIVERSITY PLACE WA
98466-4455
US

IV. Provider business mailing address

1610 BISHOP RD SW STE 101
TUMWATER WA
98512-7303
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-2999
  • Fax: 253-272-4699
Mailing address:
  • Phone: 360-338-0004
  • Fax: 360-515-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO61426650
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO61426650
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO61426650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: