Doctor Name: | DR. THOMAS SCOTT NORDQUIST |
NPI Number: | 1023470754 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 135000856 |
Business Practice Address: | 5666 E State St Rockford, IL - 611082425 |
Business Phone Number: | 8152262000 |
Business Fax Number: | |
Mailing Address: | 359 Shay Dr, ROCKFORD |
State: | IL |
Postal Code: | 611076313 |
Phone Number: | 8018303759 |
Fax Number: | |
NPI Enumeration Date: | 03/22/2016 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 135000856 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |