Provider Demographics
NPI:1205812757
Name:CUOMO JR, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CUOMO JR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11818 N 55TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4790
Mailing Address - Country:US
Mailing Address - Phone:602-859-9888
Mailing Address - Fax:480-922-5903
Practice Address - Street 1:13835 N TATUM BLVD
Practice Address - Street 2:9615
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5581
Practice Address - Country:US
Practice Address - Phone:602-859-9888
Practice Address - Fax:480-922-5903
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21499207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0723220OtherBCBS PROVIDER NUMBER
AZ170723OtherAHCCCS
AZZ69455Medicare ID - Type UnspecifiedPROVIDER ID NUMBER
AZ170723OtherAHCCCS
AZB20052Medicare UPIN