Provider Demographics
NPI:1821080300
Name:PERRY, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:PERRY
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 1:5251 W CAMPBELL AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1715
Mailing Address - Country:US
Mailing Address - Phone:623-748-9331
Mailing Address - Fax:623-748-3042
Practice Address - Street 1:8410 W THOMAS RD
Practice Address - Street 2:SUITE 116
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3329
Practice Address - Country:US
Practice Address - Phone:623-748-9331
Practice Address - Fax:623-748-3042
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14450174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ286220Medicaid
AZE45444Medicare UPIN
AZZ143504Medicare PIN
AZ286220Medicaid