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General NPI Number Information
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NPI Number | 1912334129
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Entity Type | Organization
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Legal Business Name | THOMAS E VORPAHL MD PC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 1200 N BEAVER
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-526-6380
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30488
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City | FLAGSTAFF
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State | AZ
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Zip | 86003-0488
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Country | US
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Telephone | 928-526-1112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS E VORPAHL
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Credential | MD PC
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Telephone | 928-526-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10588
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License Number State | AZ
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