Provider Demographics
NPI:1053633727
Name:LIPSCOMB, THOMAS STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STANLEY
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:S
Other - Last Name:LIPSCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:4251 SARITA COURT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4732
Mailing Address - Country:US
Mailing Address - Phone:817-923-1163
Mailing Address - Fax:817-924-3748
Practice Address - Street 1:4251 SARITA CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4732
Practice Address - Country:US
Practice Address - Phone:817-923-1163
Practice Address - Fax:817-924-3748
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-17042085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology