Healthcare Provider Details

I. General information

NPI: 1558525741
Provider Name (Legal Business Name): THOMAS CHALY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 N 3RD ST
PHOENIX AZ
85004-1401
US

IV. Provider business mailing address

2218 N 3RD ST
PHOENIX AZ
85004-1401
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-2543
  • Fax: 602-252-3861
Mailing address:
  • Phone: 602-252-2543
  • Fax: 602-252-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberGETP.TUL.SURG
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number54237
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: