Provider Demographics
NPI:1669530523
Name:THOMAS, WILBURN EARL (DPM)
Entity type:Individual
Prefix:DR
First Name:WILBURN
Middle Name:EARL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:WILBURN
Other - Middle Name:E
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4320 S GEVERS ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-2216
Mailing Address - Country:US
Mailing Address - Phone:210-533-4455
Mailing Address - Fax:210-533-4414
Practice Address - Street 1:4320 S GEVERS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-2216
Practice Address - Country:US
Practice Address - Phone:210-533-4455
Practice Address - Fax:210-533-4414
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1334213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018591001Medicaid
TX0052BTMedicare ID - Type Unspecified
TX4116970001Medicare NSC
TXU66864Medicare UPIN