Provider Demographics
NPI:1851359822
Name:DYKES, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DYKES
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 1:5001 EL PASO DR.
Mailing Address - Street 2:RADIOLOGY, MAIL STOP# 41029
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:915-215-6003
Mailing Address - Fax:915-545-6607
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-215-6003
Practice Address - Fax:915-545-6607
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4262332085R0202X
TXJ16532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013538120001Medicaid
TXJ1653OtherTX MEDICAL LICENSE - TMB
PA1013538120001Medicaid