Healthcare Provider Details

I. General information

NPI: 1891056362
Provider Name (Legal Business Name): THOMAS JAMES VERNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLTER ST UNIT 240
PHOENIX AZ
85016-3376
US

IV. Provider business mailing address

1701 E COLTER ST UNIT 240
PHOENIX AZ
85016-3376
US

V. Phone/Fax

Practice location:
  • Phone: 480-570-7082
  • Fax:
Mailing address:
  • Phone: 480-570-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54311
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: