Provider Demographics
NPI:1659570356
Name:TOMSIC, KEVIN L (MD, DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:TOMSIC
Suffix:
Gender:M
Credentials:MD, DC
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Other - First Name:
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Mailing Address - Street 1:627 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-5855
Mailing Address - Country:US
Mailing Address - Phone:936-205-5965
Mailing Address - Fax:936-205-5967
Practice Address - Street 1:627 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1247
Practice Address - Country:US
Practice Address - Phone:936-205-5965
Practice Address - Fax:936-205-5967
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6343111N00000X
OK3522111N00000X
OK27342207Q00000X
TXN7185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No111N00000XChiropractic ProvidersChiropractor