Provider Demographics
NPI:1346290442
Name:THARALSON, EUGENE F (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:F
Last Name:THARALSON
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 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5095
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:349 E CORONADO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1525
Practice Address - Country:US
Practice Address - Phone:602-266-5678
Practice Address - Fax:602-264-5646
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28034207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120390OtherGROUP MEDICARE NUMBER
AZ317047OtherGROUP MEDICAID NUMBER
AZ885413-02Medicaid
AZI02969Medicare UPIN
AZ885413-02Medicaid