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NPI Code Detail

MEDICARE: LISA ELAINE THOM MD

MEDICARE: LISA ELAINE THOM MD
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
12084P0800XPsychiatry PhysicianA116471CA
22084P0800XPsychiatry Physician49538AZ

General Provider Information

NPI Number : 1699903807
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ELAINE THOM MD
Provider Business Mailing Address
First Line : 82 S STONE AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85701-1713
Country : US
Telephone Number : 520-792-3293
Fax Number : 520-792-4336
Provider Business Practice Location Address
First Line : 8050 E LAKESIDE PKWY
Second Line :
City : TUCSON
State : AZ
Zip : 85730-1254
Country : US
Telephone Number : 520-584-5820
Fax Number : 520-514-1514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 09/13/2016

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Directions to “ LISA ELAINE THOM MD” Practice Location

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