Provider Demographics
NPI:1598794943
Name:BLOXHAM, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BLOXHAM
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 8903
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0903
Mailing Address - Country:US
Mailing Address - Phone:316-685-1337
Mailing Address - Fax:316-685-9388
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-928-8730
Practice Address - Fax:316-928-8735
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18565207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100082700AMedicaid
KS000959Medicare ID - Type Unspecified
KS100082700AMedicaid
KS000959Medicare ID - Type Unspecified
KS16880OtherCOVENTRY
KS200105OtherHPK
B91019Medicare UPIN