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General NPI Number Information
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NPI Number | 1861766560
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Entity Type | Organization
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Legal Business Name | THOMAS C GUYN MD INC
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Dates
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Enumeration Date | 02/28/2012
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 1165 MONTGOMERY DR
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City | SANTA ROSA
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State | CA
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Zip | 95405-4801
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Country | US
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Telephone | 707-525-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 122 CALISTOGA RD # 329
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City | SANTA ROSA
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State | CA
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Zip | 95409-3702
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Country | US
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Telephone | 707-547-5437
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Fax | 707-547-5430
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THOMAS C GUYN
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Credential | M.D.
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Telephone | 952-936-7736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A42640
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License Number State | CA
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