Provider Demographics
NPI:1831166685
Name:ON, THOMAS H (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:ON
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 1:22619 N 55TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-7168
Mailing Address - Country:US
Mailing Address - Phone:480-513-4898
Mailing Address - Fax:
Practice Address - Street 1:77 E COLUMBUS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2348
Practice Address - Country:US
Practice Address - Phone:602-200-9021
Practice Address - Fax:602-200-9087
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21605207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF02003Medicare UPIN
AZWMBHD24326Medicare ID - Type Unspecified