Provider Demographics
NPI:1679563159
Name:TOMLINSON, FRED B (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:B
Last Name:TOMLINSON
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MOUNT HERMON RD # A
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4086
Mailing Address - Country:US
Mailing Address - Phone:831-462-1000
Mailing Address - Fax:831-462-9519
Practice Address - Street 1:223 MOUNT HERMON RD # A
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4086
Practice Address - Country:US
Practice Address - Phone:831-462-1000
Practice Address - Fax:831-462-9519
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG804802086S0122X
CAG8048208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G80480Medicaid
942418404OtherIRS
CAA58171Medicare UPIN
000G80480Medicare ID - Type UnspecifiedMEDICARE