Basic Information
| Provider Information | |||||||||
| NPI: | 1912908096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUDEWICZ | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4679 TELESCOPE AVE | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920083766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607201878 | ||||||||
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| Practice Location | |||||||||
| Address1: | NAVAL HOSPITAL, CAMP PENDLETON | ||||||||
| Address2: | BLDG H100, SANTA MARGARITA ROAD ATTENTION: CODE CS-PA | ||||||||
| City: | CAMP PENDLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607250074 | ||||||||
| FaxNumber: | 7607251190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | A44176 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.