Provider Demographics
NPI:1487628442
Name:MOSHIRI, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:MOSHIRI
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 1:24 W CAMELBACK RD UNIT A567
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2529
Mailing Address - Country:US
Mailing Address - Phone:424-322-0980
Mailing Address - Fax:
Practice Address - Street 1:24 W CAMELBACK RD UNIT A567
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2529
Practice Address - Country:US
Practice Address - Phone:602-441-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34825208VP0014X, 207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ122856Medicaid
WA9568MOOtherINDIVIDUAL BLUE SHIELD
WA0039515OtherL& I
WA8441644Medicaid
WA8441644Medicaid
AZZ136140Medicare PIN
AZ122856Medicaid