MEDICARE: DR. THOMAS FREDERICK DISNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	14341	AZ

General Provider Information

NPI Number	:	1134337918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS FREDERICK DISNEY M.D.

Provider Business Mailing Address
First Line	:	4123 E PARADISE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1511
Country	:	US
Telephone Number	:	602-953-7446
Fax Number	:	602-953-7446

Provider Business Practice Location Address
First Line	:	4123 E PARADISE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1511
Country	:	US
Telephone Number	:	602-953-7446
Fax Number	:	602-953-7446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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