Provider Demographics
NPI:1710185152
Name:THOMAS, TOMIKA SHANTAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:TOMIKA
Middle Name:SHANTAY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SOUTH LOOP W
Mailing Address - Street 2:#1413
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2800
Mailing Address - Country:US
Mailing Address - Phone:832-660-7113
Mailing Address - Fax:
Practice Address - Street 1:2707 W BAKER RD
Practice Address - Street 2:SUITE B
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2204
Practice Address - Country:US
Practice Address - Phone:281-530-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1759213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery