Provider Demographics
NPI:1184980294
Name:TOMC, CHRISTA MICHELLE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MICHELLE
Last Name:TOMC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N LAMAR BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-0002
Mailing Address - Country:US
Mailing Address - Phone:512-617-9200
Mailing Address - Fax:512-666-3765
Practice Address - Street 1:3800 N LAMAR BLVD STE 155
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-0002
Practice Address - Country:US
Practice Address - Phone:512-617-9200
Practice Address - Fax:512-572-5178
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8170207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506009YS4ZMedicare PIN
TX506009YTAQMedicare PIN