Provider Demographics
NPI:1821061805
Name:PAXMAN, THOMAS SAMUEL (DO)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:SAMUEL
Last Name:PAXMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2690
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-7027
Mailing Address - Country:US
Mailing Address - Phone:928-367-6688
Mailing Address - Fax:928-367-4916
Practice Address - Street 1:728 E WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-7027
Practice Address - Country:US
Practice Address - Phone:928-367-6688
Practice Address - Fax:928-367-4916
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2577208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ049884Medicaid
AZ049884Medicaid
BP2259718OtherDEA
E89531Medicare UPIN