Provider Demographics
NPI:1275509846
Name:CANTY, THOMAS P (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:CANTY
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 1:20601 N 19TH AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3587
Mailing Address - Country:US
Mailing Address - Phone:602-557-0050
Mailing Address - Fax:602-557-0001
Practice Address - Street 1:20601 N 19TH AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3587
Practice Address - Country:US
Practice Address - Phone:602-557-0050
Practice Address - Fax:602-557-0001
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ186712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ291401OtherAHCCCS
AZ291401OtherAHCCCS
AZZ138123Medicare PIN