Provider Demographics
NPI:1720292550
Name:THOMAS, SUCHMOR (MD)
Entity Type:Individual
Prefix:
First Name:SUCHMOR
Middle Name:
Last Name:THOMAS
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 1:908 E SOUTHMORE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1120
Mailing Address - Country:US
Mailing Address - Phone:713-554-1091
Mailing Address - Fax:713-554-1097
Practice Address - Street 1:908 E SOUTHMORE AVE
Practice Address - Street 2:100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1134
Practice Address - Country:US
Practice Address - Phone:713-554-1091
Practice Address - Fax:713-554-1097
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8383207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720292550OtherBCBSTX
TX198511110Medicaid
TX198511109Medicaid
TX198511108Medicaid
TX1720292550OtherTRICARE SOUTH
TX198511110Medicaid
TX1720292550OtherBCBSTX
TXP00800007Medicare PIN
TXTXB107842Medicare PIN
TX198511109Medicaid