Provider Demographics
NPI:1639116338
Name:HILL, TOM DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:DANIEL
Last Name:HILL
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 1:4030 SAM HOUSTON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:936-291-9006
Mailing Address - Fax:936-291-3128
Practice Address - Street 1:4030 SAM HOUSTON AVE
Practice Address - Street 2:STE A
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-9006
Practice Address - Fax:936-291-3128
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036CUOtherBCBS
F67742Medicare UPIN
TX00004MMedicare PIN