Provider Demographics
NPI:1215129044
Name:TO, THOMAS-DUYTHUC (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS-DUYTHUC
Middle Name:
Last Name:TO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS-DUYTHUC
Other - Middle Name:
Other - Last Name:TO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1500 E 2ND ST STE 400
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1198
Practice Address - Country:US
Practice Address - Phone:775-982-2400
Practice Address - Fax:775-982-2410
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107659207RC0000X
NV15275207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215129044Medicaid
12673720OtherCAQH
NVV407964Medicare PIN