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General NPI Number Information
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NPI Number | 1659370476
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Entity Type | Individual
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Provider Name | THOMAS G GIVENS PAC
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 3015 HIGHWAY 95 SUITE 105
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-4334
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Country | US
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Telephone | 928-763-2001
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Fax | 928-763-2038
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Provider Business Mailing Address
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Address Line | PO BOX 20828
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City | BULLHEAD CITY
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State | AZ
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Zip | 86439-0828
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Country | US
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Telephone | 928-763-2001
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Fax | 928-763-2038
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3004
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License Number State | AZ
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