Provider Demographics
NPI:1598964124
Name:W. THOMAS COOMBE, MD , A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:W. THOMAS COOMBE, MD , A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-537-1042
Mailing Address - Street 1:PO BOX 3409
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-3409
Mailing Address - Country:US
Mailing Address - Phone:928-468-9280
Mailing Address - Fax:928-468-9280
Practice Address - Street 1:2051 EVERGREEN LN
Practice Address - Street 2:SUITE B
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7928
Practice Address - Country:US
Practice Address - Phone:928-537-1042
Practice Address - Fax:928-537-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36942207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218514Medicaid
AZ115806Medicare PIN
AZ218514Medicaid