Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 54237 | AZ |
N | 208200000X | Surgeon | GETP.TUL.SURG | LA |
N | 208600000X | Surgeon | GETP.TUL.SURG | LA |
NPI | 1558525741 |
---|---|
Provider Name | Dr. Thomas Chaly JR. |
First Address | Phoenix, AZ 85004-1401 |
Second Address | Phoenix, AZ 85004-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 05/02/2020 |