Provider Demographics
NPI:1558510917
Name:THOMAS, STACEY G (DO)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:G
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S CYPRESS ESTATES CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-8939
Mailing Address - Country:US
Mailing Address - Phone:281-355-8868
Mailing Address - Fax:
Practice Address - Street 1:306 S CYPRESS ESTATES CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-8939
Practice Address - Country:US
Practice Address - Phone:281-355-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1184208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice