Provider Demographics
NPI:1780670810
Name:TRUELSON, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:TRUELSON
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 1:5450 CLEARFORK MAIN ST STE 410
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3559
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-336-8034
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 410
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-336-8034
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6661208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125450006Medicaid
TX125450005Medicaid
TX125450003Medicaid
TX83Z797Medicare PIN
TXE17576Medicare UPIN
TX83Z591Medicare PIN