Provider Demographics
NPI:1942293535
Name:PETRONE, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:PETRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4350 E. RAY ROAD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044
Mailing Address - Country:US
Mailing Address - Phone:480-961-0014
Mailing Address - Fax:480-961-0024
Practice Address - Street 1:4350 E. RAY ROAD
Practice Address - Street 2:SUITE 101B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044
Practice Address - Country:US
Practice Address - Phone:602-652-8900
Practice Address - Fax:602-652-8909
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2011-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ23585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ345125Medicaid
AZB86464Medicare UPIN
AZ345125Medicaid