Provider Demographics
NPI:1457598443
Name:EIDSON, THOMAS ERIC (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ERIC
Last Name:EIDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 MATLOCK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2529
Mailing Address - Country:US
Mailing Address - Phone:817-795-8346
Mailing Address - Fax:817-717-1840
Practice Address - Street 1:2701 MATLOCK RD STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2529
Practice Address - Country:US
Practice Address - Phone:817-795-8346
Practice Address - Fax:817-717-1840
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50256202K00000X, 207Q00000X
TXN9698207Q00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307257101Medicaid