Individual
THOMAS EDWIN POORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 YGNACIO VALLEY RD # 201, WALNUT CREEK, CA 94598-3122
(925) 947-5392
(925) 947-3206
Mailing address
PO BOX 1440, SUISUN CITY, CA 94585-4440
(510) 964-0458
(510) 964-0476
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G29878
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G298781
PPIN-MEDICARE
CA
05
—
GR0060540
—
CA
Enumeration date
10/17/2006
Last updated
07/09/2007
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