Provider Demographics
NPI:1558321315
Name:ELLER, THOMAS O II (MD, FACP, CCDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:O
Last Name:ELLER
Suffix:II
Gender:M
Credentials:MD, FACP, CCDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 PAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8654
Mailing Address - Country:US
Mailing Address - Phone:254-624-7071
Mailing Address - Fax:844-704-5805
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:254-624-7071
Practice Address - Fax:844-704-5805
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127951506Medicaid
TX8F5929Medicare PIN
TXB87712Medicare UPIN