Healthcare Provider Details

I. General information

NPI: 1821061805
Provider Name (Legal Business Name): THOMAS SAMUEL PAXMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 E WHITE MOUNTAIN BLVD SUITE A
PINETOP AZ
85935-7027
US

IV. Provider business mailing address

PO BOX 2690
PINETOP AZ
85935-7027
US

V. Phone/Fax

Practice location:
  • Phone: 928-367-6688
  • Fax: 928-367-4916
Mailing address:
  • Phone: 928-367-6688
  • Fax: 928-367-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2577
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2577
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: