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General NPI Number Information
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NPI Number | 1003902834
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Entity Type | Individual
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Provider Name | THOMAS J NUCKTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 3325 CHANATE RD
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City | SANTA ROSA
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State | CA
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Zip | 95404-1707
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Country | US
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Telephone | 415-596-1685
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Fax | 415-600-1753
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Provider Business Mailing Address
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Address Line | 6 LOCKSLEY AVE APT 8J
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-3822
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Country | US
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Telephone | 415-596-1685
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Fax | 415-600-1753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CC6838711
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | G83871
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License Number State | CA
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