Provider Demographics
NPI:1134145220
Name:BACCAM, TOM N (DO)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:N
Last Name:BACCAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SANDY CORNER RD
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9693
Mailing Address - Country:US
Mailing Address - Phone:979-543-5510
Mailing Address - Fax:979-543-4137
Practice Address - Street 1:305 SANDY CORNER RD
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9693
Practice Address - Country:US
Practice Address - Phone:979-543-5510
Practice Address - Fax:979-543-4137
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044555301Medicaid
TX85Z844Medicare PIN
TXG40187Medicare UPIN