Provider Demographics
NPI:1598829707
Name:OPALACH, THADDEUS G (DO)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:G
Last Name:OPALACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:990 N WALNUT CREEK DR
Practice Address - Street 2:SUITE 2014
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1580
Practice Address - Country:US
Practice Address - Phone:817-453-2223
Practice Address - Fax:817-453-2269
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL88702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry