Provider Demographics
NPI:1396031027
Name:SHOAF, THOMAS LOWELL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LOWELL
Last Name:SHOAF
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 1:1200 E COLLINS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2457
Mailing Address - Country:US
Mailing Address - Phone:972-669-1733
Mailing Address - Fax:
Practice Address - Street 1:1200 E COLLINS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2457
Practice Address - Country:US
Practice Address - Phone:972-669-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK13002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry