Provider Demographics
NPI:1851399331
Name:MCCLOSKEY, THOMAS F (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:MCCLOSKEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2119
Mailing Address - Country:US
Mailing Address - Phone:903-597-9622
Mailing Address - Fax:903-597-1210
Practice Address - Street 1:1318 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2119
Practice Address - Country:US
Practice Address - Phone:903-597-9622
Practice Address - Fax:903-597-1210
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX988213E00000X
TX0988213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8229288OtherBCBS BLUE LINK
8229288OtherBCBS BLUE LINK
TX6067310001Medicare NSC
U29288Medicare UPIN