Individual
MATTHEW TOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9801 N METRO PKWY E, PHOENIX, AZ 85051-1513
(602) 249-0115
(602) 246-0837
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
74365
AZ
207Q00000X
Family Medicine Physician
74365
CA
207Q00000X
Family Medicine Physician
MD221871
OR
207Q00000X
Family Medicine Physician
PG205152
OR
Other
Enumeration date
04/30/2021
Last updated
10/24/2024
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