Provider Demographics
NPI:1093709776
Name:VOLATILE, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:VOLATILE
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:1327 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4443
Practice Address - Country:US
Practice Address - Phone:903-510-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI-0006680207X00000X
TXTEMPORARY207X00000X
TXM8405207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000307901Medicaid
DE510383254OtherBLUE SHIELD
TX77741OtherPHCS
TX8AM680OtherBCBS OF TEXAS
TXTIN PLUS SUFFIX 021OtherTRICARE
280888OtherMAMSI
2948060OtherAETNA HMO
42228102OtherCAREFIRST
510383254OtherTRAICARE
TX75-2616977-113OtherTRICARE
G2420012OtherDELMARVA HEALTH PLAN
A57187OtherMID ATLANTIC
4501628OtherAETNA NON HMO
TXTIN PLUS SUFFIX 016OtherTRICARE
TXTIN PLUS SUFFIX 021OtherTRICARE
280888OtherMAMSI
G2420012OtherDELMARVA HEALTH PLAN
TX8AM680OtherBCBS OF TEXAS
TXP00459710Medicare PIN