Provider Demographics
NPI:1629163829
Name:THOMAS, PAT A (DO)
Entity Type:Individual
Prefix:DR
First Name:PAT
Middle Name:A
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 1:701 PALUXY RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2355
Mailing Address - Country:US
Mailing Address - Phone:817-573-4585
Mailing Address - Fax:817-279-1153
Practice Address - Street 1:701 PALUXY RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2355
Practice Address - Country:US
Practice Address - Phone:817-573-4585
Practice Address - Fax:817-279-1153
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122763911Medicaid
TXD97785Medicare UPIN
TX1227639-02Medicaid
TXOOCB26Medicare PIN
TXTXB119996Medicare PIN
TXTXB119994Medicare PIN