Healthcare Provider Details

I. General information

NPI: 1144278375
Provider Name (Legal Business Name): THOMAS LASER CENTERS MEDICAL GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 N 32ND ST
PHOENIX AZ
85028-3851
US

IV. Provider business mailing address

10255 N 32ND ST
PHOENIX AZ
85028-3851
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-7003
  • Fax: 602-254-3474
Mailing address:
  • Phone: 602-258-7003
  • Fax: 602-254-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5773
License Number StateAZ

VIII. Authorized Official

Name: PETER THOMAS
Title or Position: OWNER
Credential: MD
Phone: 602-258-7003