Provider Demographics
NPI:1659606622
Name:JEMISON, THOMAS FISHBURNE (NMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FISHBURNE
Last Name:JEMISON
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E BROADWAY BLVD STE 124-212
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5966
Mailing Address - Country:US
Mailing Address - Phone:480-420-3254
Mailing Address - Fax:
Practice Address - Street 1:2905 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5311
Practice Address - Country:US
Practice Address - Phone:520-331-8809
Practice Address - Fax:480-420-3254
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1149175F00000X
COND.0000086175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath