Provider Demographics
NPI:1205810629
Name:KASPAR, THOMAS ADAM (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ADAM
Last Name:KASPAR
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 3744
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3744
Mailing Address - Country:US
Mailing Address - Phone:361-573-2111
Mailing Address - Fax:361-576-4219
Practice Address - Street 1:1213 HERMANN DR STE 620
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-520-6360
Practice Address - Fax:713-520-6363
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDJ0035207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137604809Medicaid
TX74-2799334OtherTAX ID NUMBER
TX00U44SMedicare ID - Type UnspecifiedMEDICARE AND BCBS OF TX #
TX322446ZU0LMedicare PIN
TXF58840Medicare UPIN