Provider Demographics
NPI:1235148230
Name:EARTHMAN, THOMAS PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PHILLIP
Last Name:EARTHMAN
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 1:2 CHELSEA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6202
Mailing Address - Country:US
Mailing Address - Phone:713-523-6627
Mailing Address - Fax:713-523-7623
Practice Address - Street 1:2 CHELSEA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6202
Practice Address - Country:US
Practice Address - Phone:713-523-6627
Practice Address - Fax:713-523-7623
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2772207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
00N261Medicare ID - Type Unspecified
B22442Medicare UPIN