Individual
THOMAS C LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 CIVIC CENTER LN, LAKE HAVASU CITY, AZ 86403-5607
(928) 854-0002
(928) 453-0885
Mailing address
13236 N 7TH ST, STE 4- 255, PHOENIX, AZ 85022-5343
(928) 854-0002
(928) 453-0885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45537
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
666099
—
AZ
Enumeration date
07/08/2010
Last updated
01/18/2012
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