Provider Demographics
NPI:1871625194
Name:HAVEL, THOMAS EARL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EARL
Last Name:HAVEL
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 1347
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94023-1347
Mailing Address - Country:US
Mailing Address - Phone:650-361-0646
Mailing Address - Fax:650-949-0303
Practice Address - Street 1:2500 GRANT RD.
Practice Address - Street 2:7025 ECH 133
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94039-7025
Practice Address - Country:US
Practice Address - Phone:650-361-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG320442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G320440Medicaid
CA00G320440Medicaid