Provider Demographics
NPI:1841315736
Name:CHANG, THOMAS J (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:CHANG
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:208 CONCOURSE BOULEVARD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8210
Mailing Address - Country:US
Mailing Address - Phone:707-544-3400
Mailing Address - Fax:707-544-0137
Practice Address - Street 1:208 CONCOURSE BOULEVARD
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:707-544-3400
Practice Address - Fax:707-544-0137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3908213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6242970001Medicare NSC
CAU44526Medicare UPIN
CA000E39080Medicare ID - Type UnspecifiedMEDICARE