Provider Demographics
NPI:1215509237
Name:COTE, THOMAS CONCANNON (SOIDC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CONCANNON
Last Name:COTE
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 RANCHO DEL ORO DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7303
Mailing Address - Country:US
Mailing Address - Phone:603-703-8221
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4101 STUART MESA RD
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:603-703-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman