Provider Demographics
NPI:1952309452
Name:YORK, THOMAS E (CRNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:YORK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 N MAJOR DR
Mailing Address - Street 2:APT 609
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9611
Mailing Address - Country:US
Mailing Address - Phone:409-767-0037
Mailing Address - Fax:
Practice Address - Street 1:4215 N MAJOR DR
Practice Address - Street 2:APT 609
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-9611
Practice Address - Country:US
Practice Address - Phone:409-767-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX437907367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130099807Medicaid
TX130099807Medicaid