Provider Demographics
NPI:1689733669
Name:PASCHALIS, THIMOS G (MD)
Entity Type:Individual
Prefix:
First Name:THIMOS
Middle Name:G
Last Name:PASCHALIS
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 1:134 VISION PARK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3032
Mailing Address - Country:US
Mailing Address - Phone:281-296-8500
Mailing Address - Fax:281-296-8501
Practice Address - Street 1:134 VISION PARK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:812-968-5002
Practice Address - Fax:281-296-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8882KOMedicare ID - Type Unspecified
TXG49618Medicare UPIN