Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 34771 | AZ |
NPI | 1083667943 |
---|---|
Provider Name | Dr. Thomas A. Eccles |
First Address | Tempe, AZ 85287-2104 |
Second Address | Tempe, AZ 85281-5390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
983610 | (05) | AZ |
D94628 | (02) |