Provider Demographics
NPI:1699903807
Name:THOM, LISA ELAINE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:THOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELAINE
Other - Last Name:RHYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:82 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1713
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-792-4336
Practice Address - Street 1:8050 E LAKESIDE PKWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1254
Practice Address - Country:US
Practice Address - Phone:520-584-5820
Practice Address - Fax:520-514-1514
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1164712084P0800X
AZ495382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry