Provider Demographics
NPI:1891848446
Name:FUTCH, THOMAS WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WAYNE
Last Name:FUTCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9322 N GAZELLE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9525
Mailing Address - Country:US
Mailing Address - Phone:520-572-6823
Mailing Address - Fax:520-572-6824
Practice Address - Street 1:4600 S PARK AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1697
Practice Address - Country:US
Practice Address - Phone:520-889-9574
Practice Address - Fax:520-889-5072
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ161912083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ128379Medicare UPIN
AZZ120952Medicare PIN