Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 21499 | AZ |
NPI | 1205812757 |
---|---|
Provider Name | Thomas J Cuomo Jr |
First Address | Scottsdale, AZ 85254-4790 |
Second Address | Phoenix, AZ 85032-5581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170723 | AHCCCS (01) | AZ |
AZ0723220 | BCBS PROVIDER NUMBER (01) | AZ |
B20052 | (02) | AZ |