Provider Demographics
NPI:1265493282
Name:DEACON, THOMAS E (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:DEACON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:228 ROYAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-4800
Mailing Address - Country:US
Mailing Address - Phone:972-293-6658
Mailing Address - Fax:
Practice Address - Street 1:2828 DUKE OF GLOUCESTER ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2067
Practice Address - Country:US
Practice Address - Phone:972-298-3888
Practice Address - Fax:972-296-0838
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE89967Medicare UPIN