Provider Demographics
NPI:1881820926
Name:THOMAS, THEO WILLIAM (IDMT)
Entity Type:Individual
Prefix:MR
First Name:THEO
Middle Name:WILLIAM
Last Name:THOMAS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RR# 2 BOX 5425 CAMP BULLIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257
Mailing Address - Country:US
Mailing Address - Phone:210-925-8336
Mailing Address - Fax:210-295-8191
Practice Address - Street 1:RR# 2 BOX 5425 CAMP BULLIS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-925-8336
Practice Address - Fax:210-295-8191
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians