Provider Demographics
NPI:1720066566
Name:AYCOCK, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:AYCOCK
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 60
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-0060
Mailing Address - Country:US
Mailing Address - Phone:254-803-3561
Mailing Address - Fax:254-883-6066
Practice Address - Street 1:322 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661-2358
Practice Address - Country:US
Practice Address - Phone:254-803-3561
Practice Address - Fax:254-883-6066
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0316614-02Medicaid
TX8W0854OtherBC/BS OF TEXAS
TX0316614-02Medicaid
TX8G3932Medicare PIN
TX8G3815Medicare PIN
TX8W0854OtherBC/BS OF TEXAS
TXB21033Medicare UPIN
TX8K3841Medicare PIN
TXP00344892Medicare PIN
TX03166140-3Medicare PIN