MEDICARE: DR. THOMAS VANCE EDDY DPM

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	213E00000X	Podiatrist	2014040487	MO

General Provider Information

NPI Number	:	1528354693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS VANCE EDDY DPM

Provider Business Mailing Address
First Line	:	5801 S FASHION BLVD
Second Line	:	STE 120
City	:	MURRAY
State	:	UT
Zip	:	84107-8115
Country	:	US
Telephone Number	:	816-525-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 S FASHION BLVD STE 120
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-8115
Country	:	US
Telephone Number	:	801-261-1391
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	12/02/2020

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