Provider Demographics
NPI:1437163862
Name:DANIELE THOMAS, M.D., P.A.
Entity Type:Organization
Organization Name:DANIELE THOMAS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-717-0587
Mailing Address - Street 1:PO BOX 12105
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-2105
Mailing Address - Country:US
Mailing Address - Phone:832-717-0587
Mailing Address - Fax:832-717-3164
Practice Address - Street 1:15910 TRANQUIL PARK CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6653
Practice Address - Country:US
Practice Address - Phone:832-717-0587
Practice Address - Fax:832-717-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160406802Medicaid
TXE67869Medicare UPIN
TX160406802Medicaid