Provider Demographics
NPI:1457443608
Name:KEOLASY, TOM P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:P
Last Name:KEOLASY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-8410
Practice Address - Street 1:810 SE MILITARY DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2823
Practice Address - Country:US
Practice Address - Phone:210-921-4200
Practice Address - Fax:210-922-8181
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-02-09
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Provider Licenses
StateLicense IDTaxonomies
TXPA04979363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant