Healthcare Provider Details

I. General information

NPI: 1982863429
Provider Name (Legal Business Name): IAN JAMES THOMAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST SUITE 3015
PHOENIX AZ
85020-2437
US

IV. Provider business mailing address

6120 W BELL RD STE 130
GLENDALE AZ
85308-3782
US

V. Phone/Fax

Practice location:
  • Phone: 602-300-4830
  • Fax: 602-995-3795
Mailing address:
  • Phone: 623-512-4326
  • Fax: 623-512-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number390200000X
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036139212
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number005782
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: