Healthcare Provider Details

I. General information

NPI: 1982660213
Provider Name (Legal Business Name): THOMAS F. MERTINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18185 N 83RD AVE BLDG D, SUITE 107
GLENDALE AZ
85308-0516
US

IV. Provider business mailing address

18185 N 83RD AVE BLDG D, SUITE 107
GLENDALE AZ
85308-0516
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-0306
  • Fax: 623-583-1349
Mailing address:
  • Phone: 623-583-0306
  • Fax: 623-583-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number268583
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: