Provider Demographics
NPI:1417007758
Name:THOMAS, MICHAEL M (PAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7010 W ADAMS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5550
Mailing Address - Country:US
Mailing Address - Phone:254-228-1400
Mailing Address - Fax:254-228-1401
Practice Address - Street 1:7010 W ADAMS AVE STE 200
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5550
Practice Address - Country:US
Practice Address - Phone:254-228-1400
Practice Address - Fax:254-228-1401
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03252207P00000X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant