Healthcare Provider Details

I. General information

NPI: 1902632664
Provider Name (Legal Business Name): ALLIANCE MEDICAL SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 S WATSON RD STE 205
BUCKEYE AZ
85326-3470
US

IV. Provider business mailing address

13660 N 94TH DR STE D1
PEORIA AZ
85381-4275
US

V. Phone/Fax

Practice location:
  • Phone: 623-974-0522
  • Fax:
Mailing address:
  • Phone: 623-974-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY THOMAS
Title or Position: MANAGER
Credential: DPM
Phone: 623-512-1633