Basic Information
| Provider Information | |||||||||
| NPI: | 1952309908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSTOE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 SAN JOSE ST | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317582100 | ||||||||
| FaxNumber: | 8317581565 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 SAN JOSE ST | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317582100 | ||||||||
| FaxNumber: | 8317581565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 11/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | A43634 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 110126163 | 01 | CA | RAILROAD MEDICARE SVMH READING | OTHER | A00043634 | 01 | CA | BLUE CROSS | OTHER | 110074639 | 01 | CA | RAILROAD MEDICARE CCC | OTHER | 00A436340 | 05 | CA | MEDICAID |