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General NPI Number Information
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NPI Number | 1902837289
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Entity Type | Individual
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Provider Name | TOM RYAN DEMEESTER MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 1510 SAN PABLO ST SUITE 514
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City | LOS ANGELES
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State | CA
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Zip | 90033-5324
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Country | US
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Telephone | 323-442-5910
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Fax | 323-442-6798
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Provider Business Mailing Address
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Address Line | 1510 SAN PABLO ST SUITE 514
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City | LOS ANGELES
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State | CA
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Zip | 90033-5324
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Country | US
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Telephone | 323-442-5910
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Fax | 323-442-6798
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C42820
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License Number State | CA
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