Provider Demographics
NPI:1811086655
Name:CATHEY, THOMAS GORDON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GORDON
Last Name:CATHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WEST EXCHANGE ST
Mailing Address - Street 2:#500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-232-4200
Mailing Address - Fax:651-232-4119
Practice Address - Street 1:17 WEST EXCHANGE ST
Practice Address - Street 2:#500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-232-4200
Practice Address - Fax:651-232-4119
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN20855OtherMEDICAL LICENSE
MN415783400Medicaid
110008221Medicare ID - Type Unspecified
MN20855OtherMEDICAL LICENSE