Provider Demographics
NPI:1114624129
Name:HOUSTON, THOMAS DEWEY III
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DEWEY
Last Name:HOUSTON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 SAPLING CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-4539
Mailing Address - Country:US
Mailing Address - Phone:720-536-8428
Mailing Address - Fax:
Practice Address - Street 1:4386 TRAIL BOSS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7512
Practice Address - Country:US
Practice Address - Phone:720-926-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COST.0006562246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COST.0006562OtherSURGICAL TECH LICENSE