Individual
DR. THOMAS DUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 DOYLE PARK DR STE 303, SANTA ROSA, CA 95405-4559
(707) 575-1833
(707) 575-3561
Mailing address
500 DOYLE PARK DR STE 303, SANTA ROSA, CA 95405-4559
(707) 575-1833
(707) 575-3561
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G58176
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G581760
—
CA
01
—
ZZZ19545Z
BLUE SHIELD
CA
Enumeration date
07/13/2006
Last updated
07/08/2007
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