Provider Demographics
NPI:1821189416
Name:THOMAS N GLOW DPM PC
Entity Type:Organization
Organization Name:THOMAS N GLOW DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:GLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:520-458-6838
Mailing Address - Street 1:3965 FOOTHILLS DR
Mailing Address - Street 2:STE B
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-458-6838
Mailing Address - Fax:520-458-0373
Practice Address - Street 1:3965 FOOTHILLS DR
Practice Address - Street 2:STE B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-458-6838
Practice Address - Fax:520-458-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T41651Medicare UPIN