Healthcare Provider Details

I. General information

NPI: 1053653576
Provider Name (Legal Business Name): CHOUA THAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E THOMAS RD
PHOENIX AZ
85016-7711
US

IV. Provider business mailing address

1155 MILL ST MS M14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 602-532-1000
  • Fax:
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number63680
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD044299
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number18922
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE-15968
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number18922
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA162785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: