Provider Demographics
NPI:1184660839
Name:THOMISON, JAMES LEE II (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:THOMISON
Suffix:II
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 1:301 E OVILLA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3833
Mailing Address - Country:US
Mailing Address - Phone:972-617-5225
Mailing Address - Fax:972-617-7922
Practice Address - Street 1:301 E OVILLA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3833
Practice Address - Country:US
Practice Address - Phone:972-617-5225
Practice Address - Fax:972-617-7922
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102076005Medicaid
TX81838SOtherBCBS
TX8BR118OtherBCBS
TX1020760-04Medicaid
TXH09193Medicare UPIN
TX8F3667Medicare PIN
TX1020760-04Medicaid
TXP00717146Medicare PIN
TX080172393Medicare PIN