Provider Demographics
NPI:1619905502
Name:ALEXANDER JR SERVICES, THOMAS
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ALEXANDER JR SERVICES
Suffix:
Gender:M
Credentials:
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 6813
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6813
Mailing Address - Country:US
Mailing Address - Phone:903-592-8685
Mailing Address - Fax:903-597-3129
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 850
Practice Address - Street 2:SOUTHWESTERN CEREBRAL CIRCULATORY DYNAMICS
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1955
Practice Address - Country:US
Practice Address - Phone:903-592-8685
Practice Address - Fax:903-597-3129
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0037DCOtherBCBS
TX0036DCOtherBCBS
TX0035DCOtherBCBS