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General NPI Number Information
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NPI Number | 1841873437
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Entity Type | Individual
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Provider Name | MATTHEW TOM
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Gender | Male
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 9801 N METRO PKWY E
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City | PHOENIX
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State | AZ
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Zip | 85051-1513
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Country | US
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Telephone | 602-249-0115
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Fax | 602-246-0837
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PG205152
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD221871
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 74365
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 74365
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License Number State | AZ
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