Provider Demographics
NPI:1477608347
Name:ALEXANDER, THOMAS KUNNUMPURATHU (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KUNNUMPURATHU
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 W CAMPBELL RD
Mailing Address - Street 2:SUITE #212
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3595
Mailing Address - Country:US
Mailing Address - Phone:972-234-4994
Mailing Address - Fax:972-234-4412
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:SUITE #212
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-234-4994
Practice Address - Fax:972-234-4412
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00086AROMedicaid
TX0086ARMedicare PIN
TXP00086AROMedicaid