Provider Demographics
NPI:1013084912
Name:BOROK, THOMAS LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LOUIS
Last Name:BOROK
Suffix:
Gender:M
Credentials:MD
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 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
Is Sole Proprietor?:No
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?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO8820196Medicaid
897859945OtherIMP
LK20882019Medicare ID - Type Unspecified
TXPO8820196Medicaid
882019Medicare ID - Type Unspecified