Individual
THOMAS J WALISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1008 E MCDOWELL RD STE A, PHOENIX, AZ 85006-2603
(602) 358-8588
(602) 688-6991
Mailing address
7330 N 16TH ST STE B101, PHOENIX, AZ 85020-5274
(602) 358-8588
(602) 688-6991
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
39552
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18335535
—
CO
01
—
348308
MEDICARE GROUP NUMBER
CO
01
—
51250331
MEDICAID GROUP NUMBER
CO
01
—
810211
MEDICARE GROUP PTAN
CO
01
—
98103776
MEDICAID PRACTICE NUMBER
CO
01
—
C810211
MEDICARE GROUP NUMBER
CO
Enumeration date
07/23/2006
Last updated
12/18/2023
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