Provider Demographics
NPI:1467429241
Name:WAITZ, THOMAS CLAIBORNE (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CLAIBORNE
Last Name:WAITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:CLAIBORNE
Other - Last Name:WAITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:7720 NORTH 17TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-997-6062
Mailing Address - Fax:602-870-3130
Practice Address - Street 1:7720 NORTH 17TH AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-997-6062
Practice Address - Fax:602-870-3130
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007083208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ227901OtherSTATE AHCCCS
AZ227901OtherSTATE AHCCCS