Provider Demographics
NPI:1174687651
Name:THOMAS, DANNY RAY (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:RAY
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 1:6100 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3930
Mailing Address - Country:US
Mailing Address - Phone:817-989-1595
Mailing Address - Fax:817-989-1175
Practice Address - Street 1:6100 SOUTHWEST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3930
Practice Address - Country:US
Practice Address - Phone:817-989-1595
Practice Address - Fax:817-989-1175
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4595207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC22606Medicare UPIN
TX00AQ76Medicare ID - Type Unspecified
TX00AQ76Medicare ID - Type Unspecified