Provider Demographics
NPI:1881836682
Name:THOMAS JR, PATRICK SHANE JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SHANE
Last Name:THOMAS JR
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 GESSNER RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2853
Mailing Address - Country:US
Mailing Address - Phone:713-973-1007
Mailing Address - Fax:713-973-0104
Practice Address - Street 1:929 GESSNER RD STE 2000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-973-1007
Practice Address - Fax:713-973-0104
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1155592084P0800X
TXR14642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881836682Medicaid
CA1881836682Medicaid