Provider Demographics
NPI:1770500365
Name:THOMAS, RAYMOND RUSSELL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:RUSSELL
Last Name:THOMAS
Suffix:JR
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 1:610 SOUTH AUSTIN ROAD
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:77434-3202
Mailing Address - Country:US
Mailing Address - Phone:979-234-2551
Mailing Address - Fax:979-234-5994
Practice Address - Street 1:610 SOUTH AUSTIN ROAD
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:TX
Practice Address - Zip Code:77434-3202
Practice Address - Country:US
Practice Address - Phone:979-234-2551
Practice Address - Fax:979-234-5994
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7227207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136696509Medicaid
TX00202NMedicare PIN
TX136696509Medicaid
TX458804Medicare Oscar/Certification