Basic Information
| Provider Information | |||||||||
| NPI: | 1275509846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20601 N 19TH AVE | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850273587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025570050 | ||||||||
| FaxNumber: | 6025570001 | ||||||||
| Practice Location | |||||||||
| Address1: | 20601 N 19TH AVE | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850273587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025570050 | ||||||||
| FaxNumber: | 6025570001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 18671 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 291401 | 01 | AZ | AHCCCS | OTHER |