Provider Demographics
NPI:1124037551
Name:THOMAS, MILTON DEAN (MD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:DEAN
Last Name:THOMAS
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 1:909 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1520
Mailing Address - Country:US
Mailing Address - Phone:214-820-9637
Mailing Address - Fax:214-820-9339
Practice Address - Street 1:909 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1520
Practice Address - Country:US
Practice Address - Phone:214-820-9637
Practice Address - Fax:214-820-9339
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0698208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105592304Medicaid
TX8BR153OtherBCBS
TX105592303Medicaid
TXD07699Medicare UPIN
TXP00731592Medicare PIN
TX8BR153OtherBCBS
TX86371NMedicare PIN
TX250012426Medicare PIN
TX8L3010Medicare PIN