Provider Demographics
NPI:1467444141
Name:SCHOLLER, THOMAS R (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:SCHOLLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:703 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2015
Practice Address - Country:US
Practice Address - Phone:903-606-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184589301Medicaid
TX184589303Medicaid
TX8161NLOtherBCBS
TX184589302Medicaid
TX752616977180OtherTRICARE
TXP01569660OtherRAIL ROAD MEDICARE
TX750818167015OtherTRICARE
TX82N309OtherBCBS OF TEXAS
TX8905NKOtherBCBS
TX75-2616977-122OtherTRICARE
TX8905NKOtherBCBS
TX752616977180OtherTRICARE
TX291231YS6PMedicare PIN
TX750818167015OtherTRICARE
R32009Medicare UPIN
TX291231YMAFMedicare UPIN
TXP01380854Medicare Oscar/Certification