Provider Demographics
NPI:1417981804
Name:KINGMAN, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:KINGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4410 MEDICAL DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3755
Mailing Address - Country:US
Mailing Address - Phone:210-615-5200
Mailing Address - Fax:210-615-5206
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3755
Practice Address - Country:US
Practice Address - Phone:210-615-5200
Practice Address - Fax:210-615-5206
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF6822207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089529402Medicaid
TX00QD13Medicare PIN
TX089529402Medicaid