Provider Demographics
NPI:1700837853
Name:GARLAND, THOMAS F (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:GARLAND
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:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-0489
Mailing Address - Country:US
Mailing Address - Phone:602-789-0344
Mailing Address - Fax:
Practice Address - Street 1:3380 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2262
Practice Address - Country:US
Practice Address - Phone:602-789-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34116207Q00000X
AZ63126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906179Medicaid
NC2067698BOtherMEDICARE PTAN
2067698OtherMEDICARE PTAN
SCNC1326Medicaid
2067698AOtherMEDICARE PTAN
SCAA76621879Medicare PIN