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NPI Code Detail

MEDICARE: DR. EUGENE F. THARALSON M.D.

MEDICARE: DR. EUGENE F. THARALSON 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
1207RG0100XGastroenterology Physician28034AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1120390OTHERAZGROUP MEDICARE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346290442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EUGENE F. THARALSON M.D.
Provider Business Mailing Address
First Line : 3020 E CAMELBACK RD
Second Line : SUITE 301
City : PHOENIX
State : AZ
Zip : 85016-5095
Country : US
Telephone Number : 602-264-9100
Fax Number : 602-264-9101
Provider Business Practice Location Address
First Line : 349 E CORONADO RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1525
Country : US
Telephone Number : 602-266-5678
Fax Number : 602-264-5646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 02/16/2017

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