Provider Demographics
NPI:1336457696
Name:PAT A. THOMAS, D.O., P.A.
Entity Type:Organization
Organization Name:PAT A. THOMAS, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-573-4585
Mailing Address - Street 1:701 PALUXY RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2355
Mailing Address - Country:US
Mailing Address - Phone:817-573-4585
Mailing Address - Fax:682-498-8096
Practice Address - Street 1:701 PALUXY RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2355
Practice Address - Country:US
Practice Address - Phone:817-573-4585
Practice Address - Fax:682-498-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1227639-02Medicaid
TXD97785Medicare UPIN
TXOOCB26Medicare PIN