Provider Demographics
NPI:1861564593
Name:IDZOREK, THOMAS SCOTT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:IDZOREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10752 N 89TH PLACE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6743
Mailing Address - Country:US
Mailing Address - Phone:480-860-9272
Mailing Address - Fax:
Practice Address - Street 1:10752 N 89TH PLACE
Practice Address - Street 2:SUITE 123
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6743
Practice Address - Country:US
Practice Address - Phone:480-860-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C99678Medicare UPIN