Individual
THOMAS PRENDERGAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
625 SILVER SW, SUITE A, ALBUQUERQUE, NM 87114-5218
(800) 893-9698
(337) 371-4738
Mailing address
PO BOX 661597, ARCADIA, CA 91066-1597
(626) 447-0296
(626) 447-6057
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A716-80
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX60300
—
CA
Enumeration date
07/26/2006
Last updated
06/23/2008
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