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NPI Code Detail

MEDICARE: MATTHEW TOM

MEDICARE: MATTHEW TOM
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
1207Q00000XFamily Medicine PhysicianPG205152OR
2207Q00000XFamily Medicine PhysicianMD221871OR
3207Q00000XFamily Medicine Physician74365CA
4207Q00000XFamily Medicine Physician74365AZ

General Provider Information

NPI Number : 1841873437
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW TOM
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9801 N METRO PKWY E
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1513
Country : US
Telephone Number : 602-249-0115
Fax Number : 602-246-0837
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2021
Last Update Date : 10/24/2024

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Directions to “ MATTHEW TOM ” Practice Location

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