Healthcare Provider Details

I. General information

NPI: 1710471529
Provider Name (Legal Business Name): JEFF THOMAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 N 94TH DR STE D1
PEORIA AZ
85381-4275
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: 623-933-5787
Mailing address:
  • Phone: 623-974-0522
  • Fax: 623-933-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0768
License Number StateAZ

VIII. Authorized Official

Name: DR. JEFFREY THOMAS
Title or Position: OWNER
Credential: DPM
Phone: 623-512-1633