Provider Demographics
NPI:1780609768
Name:TOMASZEK, DAVID EDWARD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:TOMASZEK
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 1:111 VISION PARK BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3002
Mailing Address - Country:US
Mailing Address - Phone:936-321-1130
Mailing Address - Fax:936-321-1230
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-321-1130
Practice Address - Fax:936-321-1230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9191207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7210Medicare ID - Type Unspecified
TXC86795Medicare UPIN