Provider Demographics
NPI:1508891623
Name:FITZHARRIS, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:FITZHARRIS
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 1:10405 E NORTHWEST HWY
Mailing Address - Street 2:#100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4619
Mailing Address - Country:US
Mailing Address - Phone:214-321-6485
Mailing Address - Fax:214-324-3187
Practice Address - Street 1:10405 E NORTHWEST HWY
Practice Address - Street 2:#100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4619
Practice Address - Country:US
Practice Address - Phone:214-321-6485
Practice Address - Fax:214-324-3187
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100930001Medicaid
TX100930001Medicaid
B22712Medicare UPIN