Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 27673 | AZ |
N | 208600000X | Surgeon | 27673 | AZ |
NPI | 1003808072 |
---|---|
Provider Name | Dr. Tom Alan Wolvos |
First Address | Scottsdale, AZ 85251-5649 |
Second Address | Scottsdale, AZ 85251-5649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 22/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
861017961 | FED TAX ID (01) | |
A38485 | (02) | AZ |