Healthcare Provider Details

I. General information

NPI: 1639190572
Provider Name (Legal Business Name): THOMAS J WALISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 E MCDOWELL RD STE A
PHOENIX AZ
85006-2603
US

IV. Provider business mailing address

2222 E HIGHLAND AVE STE 205
PHOENIX AZ
85016-4876
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-8588
  • Fax: 602-688-6991
Mailing address:
  • Phone: 602-358-8588
  • Fax: 602-688-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number37943
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: