Provider Demographics
NPI:1851846018
Name:WORTHINGTON, THOMAS MASON JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MASON
Last Name:WORTHINGTON
Suffix:JR
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 1:9141 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0409
Mailing Address - Country:US
Mailing Address - Phone:903-581-6848
Mailing Address - Fax:
Practice Address - Street 1:9141 CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0409
Practice Address - Country:US
Practice Address - Phone:903-581-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine