Provider Demographics
NPI:1801955349
Name:THOMAS, MICHAEL P (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2929 CALDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-654-6886
Practice Address - Street 1:2400 HIGHWAY 365
Practice Address - Street 2:SUITE 201
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6249
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-654-6912
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7112207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107604706Medicaid
TXP00721266Medicare PIN
TXG85049Medicare UPIN
TX107604706Medicaid