Provider Demographics
NPI:1295003382
Name:DANNY R. THOMAS, M.D., P.A.
Entity Type:Organization
Organization Name:DANNY R. THOMAS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-989-1595
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4595207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty