Provider Demographics
NPI:1821082520
Name:LUNSFORD, THOMAS MASON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MASON
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 OAK DR S
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5629
Mailing Address - Country:US
Mailing Address - Phone:979-299-1520
Mailing Address - Fax:979-299-1421
Practice Address - Street 1:215 OAK DR S
Practice Address - Street 2:SUITE F
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5629
Practice Address - Country:US
Practice Address - Phone:979-299-1520
Practice Address - Fax:979-299-1421
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7160207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035823601Medicaid
B24520Medicare UPIN
TXTXB134712Medicare PIN