MEDICARE: THOMAS H HIRASA MD

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
1	208600000X	Surgery Physician	37662	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922016682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS H HIRASA MD

Provider Business Mailing Address
First Line	:	804 AINSWORTH DRIVE
Second Line	:	SUITE 103
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1624
Country	:	US
Telephone Number	:	928-771-1011
Fax Number	:	928-771-1332

Provider Business Practice Location Address
First Line	:	804 AINSWORTH DR
Second Line	:	SUITE 103
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1624
Country	:	US
Telephone Number	:	928-771-1011
Fax Number	:	928-771-1332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	10/12/2012

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Directions to “ THOMAS H HIRASA MD” Practice Location

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