Provider Demographics
NPI:1548203987
Name:CURTIS, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CURTIS
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:2026 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5822
Practice Address - Country:US
Practice Address - Phone:903-589-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6144207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010LBOtherBLUE CROSS BLUE SHIELD
TX136722922Medicaid
TX75-0818167-022OtherTRICARE
TX75-0818167-048OtherTRICARE
TX75-2616977-002OtherTRICARE
TX8DU769OtherBCBS
TX75-2616977-001OtherTRICARE
TX8DU784OtherBCBS
TX136722912Medicaid
TX75-2616977-028OtherTRICARE
TXTXB112318Medicare Oscar/Certification
TX930122126Medicare PIN
TXP00882974Medicare PIN
TX610449Medicare PIN
TX8DU769OtherBCBS
TXE16399Medicare UPIN
TX136722922Medicaid