Provider Demographics
NPI:1992865422
Name:THOMASON, ROLAND H (CRNA)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:H
Last Name:THOMASON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240209367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039993301Medicaid
TX039993303OtherCSHCN
TX1899908OtherUHC PIN
TX10033962OtherAMERIGROUP PIN
1447220850OtherGRP NPI NUMBER
TX137345809OtherMEDICAID GROUP TPI
TX140442853OtherCSHCN GROUP TPI
TX10033962OtherAMERIGROUP PIN
TX00N47FMedicare ID - Type UnspecifiedGRP MEDICARE
S60229Medicare UPIN