Healthcare Provider Details
I. General information
NPI: 1992917652
Provider Name (Legal Business Name): THOMAS J RICK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/04/2007
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4441 E MCDOWELL RD SUITE 101
PHOENIX AZ
85008-4503
US
IV. Provider business mailing address
PO BOX 29211
PHOENIX AZ
85038-9211
US
V. Phone/Fax
- Phone: 602-273-6770
- Fax: 602-889-0489
- Phone: 602-273-6770
- Fax: 602-889-0489
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
THOMAS
J
RICK
Title or Position: OWNER
Credential: M.D.
Phone: 602-273-6770