MEDICARE: JOHN DAVID TOMASIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	G60256	CA
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	G60256	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053365007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID TOMASIN M.D.

Provider Business Mailing Address
First Line	:	3536 MENDOCINO AVE
Second Line	:	STE 200
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3634
Country	:	US
Telephone Number	:	707-525-6485
Fax Number	:	707-433-6674

Provider Business Practice Location Address
First Line	:	1310 PRENTICE DR
Second Line	:	STE G
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3384
Country	:	US
Telephone Number	:	707-433-0126
Fax Number	:	707-433-6674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/08/2012

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Directions to “ JOHN DAVID TOMASIN M.D.” Practice Location

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