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NPI Code Detail

MEDICARE: MR. JERRY JOSE THOMAS M.D.

MEDICARE:  MR. JERRY JOSE THOMAS  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianC55780CA
22084P0800XPsychiatry Physician59732AZ

General Provider Information

NPI Number : 1811195126
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JERRY JOSE THOMAS M.D.
Provider Business Mailing Address
First Line : CARL T. HAYDEN VETERANS ADMINISTRATION MEDICAL CENTER
Second Line : 650 EAST INDIAN SCHOOL ROAD
City : PHOENIX
State : AZ
Zip : 85012-1839
Country : US
Telephone Number : 602-277-5551
Fax Number :
Provider Business Practice Location Address
First Line : CARL T. HAYDEN VETERANS ADMINISTRATION MEDICAL CENTER
Second Line : 650 EAST INDIAN SCHOOL ROAD
City : PHOENIX
State : AZ
Zip : 85012-1839
Country : US
Telephone Number : 602-277-5551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2007
Last Update Date : 07/19/2023

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