Provider Demographics
NPI:1164439303
Name:THOMAS, FRED C (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
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 1:9353 ELAM RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4181
Mailing Address - Country:US
Mailing Address - Phone:214-931-1158
Mailing Address - Fax:214-398-0212
Practice Address - Street 1:9353 ELAM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4181
Practice Address - Country:US
Practice Address - Phone:214-931-1158
Practice Address - Fax:214-398-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130899104Medicaid
TX130899106Medicaid
TX0012EAOtherBLUE SHIELD
10838892OtherCAQH
TX0012EAOtherBLUE SHIELD
TX130899104Medicaid