Thomas T Mesdag, DPM
Individual provider Active NPI Podiatrist · Monmouth, OR
NPI 1811091044 · NPPES record last updated Aug 3, 2011
Key facts
- NPI
- 1811091044
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- OP00145 (OR)
- Practice address
- 343 E Main St
Monmouth, OR 97361 - Phone
- (503) 838-3668
- Fax
- (503) 606-2944
- NPI assigned
- Sep 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OP00145 | OR | MD | Podiatrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | OP00145 | OR | Yes |
Addresses
Primary practice location
343 E Main St
Monmouth, OR 97361
Mailing address
PO Box 95
Monmouth, OR 97361
Phone (503) 838-3668
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 268177 | Medicaid | OR |
Other providers in Monmouth, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.