Provider Demographics
NPI:1922175827
Name:THOMAS LOUIS BOROK, MD, PA
Entity Type:Organization
Organization Name:THOMAS LOUIS BOROK, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BOROK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-931-1073
Mailing Address - Street 1:PO BOX 702806
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-2806
Mailing Address - Country:US
Mailing Address - Phone:972-931-1073
Mailing Address - Fax:972-931-1073
Practice Address - Street 1:5004 SPYGLASS DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7429
Practice Address - Country:US
Practice Address - Phone:972-931-1073
Practice Address - Fax:972-931-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF84202085R0001X
GA318792085R0001X
IN01053626A2085R0001X
WI419830202085R0001X
MT104802085R0001X
WI41983-0202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
897859945OtherIMP
TXPO8820196Medicaid
897859945OtherIMP
882019Medicare ID - Type Unspecified
LK20882019Medicare ID - Type Unspecified