Healthcare Provider Details

I. General information

NPI: 1164491437
Provider Name (Legal Business Name): THOMAS W BUENKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4577 W PECOS RD
LAVEEN AZ
85339-9002
US

IV. Provider business mailing address

10105 EAST VIA LINDA SUITE 103, PMB 395
SCOTTSDALE AZ
85258-5326
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30034
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: