Provider Demographics
NPI:1942280268
Name:CANFIELD, THOMAS M (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:CANFIELD
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:PO BOX 2085
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-2085
Mailing Address - Country:US
Mailing Address - Phone:970-240-7220
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:800 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4212
Practice Address - Country:US
Practice Address - Phone:970-240-7220
Practice Address - Fax:970-497-8410
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15144207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01151448Medicaid
CO220022480OtherRAILROAD MEDICARE
COD22797Medicare UPIN
COC71914Medicare PIN