Provider Demographics
NPI:1700816469
Name:PRICE, TOMMY CHRIS (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:CHRIS
Last Name:PRICE
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 1:3360 N APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-8404
Mailing Address - Country:US
Mailing Address - Phone:602-316-1587
Mailing Address - Fax:
Practice Address - Street 1:1900 N HIGLEY ROAD
Practice Address - Street 2:BANNER GATEWAY MEDICAL CENTER
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-543-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12453207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ24734Medicare UPIN
AZD44368Medicare UPIN