Provider Demographics
NPI:1114227501
Name:FACELLE, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:FACELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 29048
Mailing Address - Street 2:MSC: 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9048
Mailing Address - Country:US
Mailing Address - Phone:303-985-2550
Mailing Address - Fax:303-985-2586
Practice Address - Street 1:400 INDIANA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5027
Practice Address - Country:US
Practice Address - Phone:303-985-2550
Practice Address - Fax:303-985-2586
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0054957208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program