Provider Demographics
NPI:1568643757
Name:DALLMAN, THOMAS GARY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GARY
Last Name:DALLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1355 RAMAR RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7100
Mailing Address - Country:US
Mailing Address - Phone:928-763-9505
Mailing Address - Fax:928-763-7370
Practice Address - Street 1:1355 RAMAR RD
Practice Address - Street 2:SUITE 12
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7100
Practice Address - Country:US
Practice Address - Phone:928-763-9505
Practice Address - Fax:928-763-7370
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2022-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ16390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110023320OtherPALMETTO R/R GBA
AZAZ0189940OtherBLUE CROSS BLUE SHIELD AZ
AZ110023320OtherPALMETTO R/R GBA