Provider Demographics
NPI:1144281528
Name:GOERGEN, THOMAS G (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:GOERGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 462750
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-2750
Mailing Address - Country:US
Mailing Address - Phone:760-520-8500
Mailing Address - Fax:760-520-8523
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3363
Practice Address - Country:US
Practice Address - Phone:760-739-5400
Practice Address - Fax:760-739-8471
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC332092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C332090Medicaid
CAWC33209AMedicare PIN
CA00C332090Medicaid
CAWC33209BMedicare PIN
CAWC33209HMedicare PIN
CAWC33209FMedicare PIN
CAWC33209GMedicare PIN