Provider Demographics
NPI:1225119746
Name:REICHENBACHER, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:REICHENBACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 N ORACLE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5604
Mailing Address - Country:US
Mailing Address - Phone:520-639-8746
Mailing Address - Fax:520-900-7256
Practice Address - Street 1:6650 N ORACLE RD STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5604
Practice Address - Country:US
Practice Address - Phone:520-639-8746
Practice Address - Fax:520-900-7256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ306922084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ722646Medicaid
AZ722646Medicaid
E99153Medicare UPIN