Healthcare Provider Details

I. General information

NPI: 1801923602
Provider Name (Legal Business Name): THOMAS JOSEPH VALENTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S 6TH ST
COTTONWOOD AZ
86326-4237
US

IV. Provider business mailing address

55 S 6TH ST
COTTONWOOD AZ
86326-4237
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-5118
  • Fax: 928-634-8522
Mailing address:
  • Phone: 928-634-5118
  • Fax: 928-634-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036113467
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number37382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: