Provider Demographics
NPI:1750690335
Name:STRAWN, THOMAS BRENT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRENT
Last Name:STRAWN
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 1:19420 N 59TH AVE
Mailing Address - Street 2:SUITE B233
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6894
Mailing Address - Country:US
Mailing Address - Phone:623-234-2542
Mailing Address - Fax:623-234-2543
Practice Address - Street 1:9515 W CAMELBACK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:623-581-8346
Practice Address - Fax:623-581-8347
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27620174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ273316090OtherTAX ID