Provider Demographics
NPI:1962466797
Name:JENNINGS, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:400 HOSPITAL DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110
Mailing Address - Country:US
Mailing Address - Phone:903-654-1171
Mailing Address - Fax:903-654-1849
Practice Address - Street 1:400 HOSPITAL DR
Practice Address - Street 2:SUITE 115
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110
Practice Address - Country:US
Practice Address - Phone:888-215-1999
Practice Address - Fax:214-379-1849
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN3760207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383311970100OtherCOMMUNITY CHOICE MICHIGAN
MI0110107OtherBCBSM MEDICARE ADVANTAGE
MI329013810Medicaid
MI0809937OtherSECURE HORIZON DIRECT
MI1801101071OtherBLUE CROSS BLUE SHIELD MI
MI0110107OtherMEDICARE PLUS BLUE
MI1014313OtherBERRIEN HEALTH PLAN
MI180027174OtherRR MEDICARE
MI383311970100OtherCOMMUNITY CHOICE MICHIGAN
MI1801101071OtherBLUE CROSS BLUE SHIELD MI
MI180027174OtherRR MEDICARE