Provider Demographics
NPI:1477517639
Name:STATON, TOM KEVIN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:KEVIN
Last Name:STATON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1655 NE LOOP 286
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460
Mailing Address - Country:US
Mailing Address - Phone:903-739-9191
Mailing Address - Fax:
Practice Address - Street 1:1655 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-739-9191
Practice Address - Fax:972-939-4542
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0715Medicare ID - Type UnspecifiedDENTON COUNTY
TX8D0714Medicare ID - Type UnspecifiedDALLAS COUNTY