Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0658 | AZ |
NPI | 1003932328 |
---|---|
Provider Name | Tanya L Thoms |
First Address | Glendale, AZ 85318-1163 |
Second Address | Peoria, AZ 85382-8155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 21/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
294773 | (05) | AZ |