Basic Information
| Provider Information | |||||||||
| NPI: | 1891848446 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUTCH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9322 N GAZELLE PL | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857429525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205726823 | ||||||||
| FaxNumber: | 5205726824 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 S PARK AVE | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857141697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208899574 | ||||||||
| FaxNumber: | 5208895072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 06/05/2009 | ||||||||
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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 | 2083X0100X | 16191 | AZ | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.