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General NPI Number Information
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NPI Number | 1639190572
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Entity Type | Individual
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Provider Name | THOMAS J WALISER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 1008 E MCDOWELL RD STE A
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City | PHOENIX
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State | AZ
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Zip | 85006-2603
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Country | US
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Telephone | 602-358-8588
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Fax | 602-688-6991
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Provider Business Mailing Address
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Address Line | 7330 N 16TH ST STE B101
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City | PHOENIX
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State | AZ
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Zip | 85020-5274
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Country | US
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Telephone | 602-358-8588
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Fax | 602-688-6991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 39552
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License Number State | CO
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