Healthcare Provider Details

I. General information

NPI: 1225236367
Provider Name (Legal Business Name): THOMAS J CUOMO JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13835 N TATUM BLVD # 9468
PHOENIX AZ
85032-5581
US

IV. Provider business mailing address

13835 N TATUM BLVD # 9468
PHOENIX AZ
85032-5581
US

V. Phone/Fax

Practice location:
  • Phone: 602-859-9888
  • Fax: 480-922-5903
Mailing address:
  • Phone: 602-859-9888
  • Fax: 480-922-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number21499
License Number StateAZ

VIII. Authorized Official

Name: DR. THOMAS J CUOMO JR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 602-859-9888