Provider Demographics
NPI:1902812944
Name:GRABOW, THOMAS W (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:GRABOW
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 167
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-0167
Mailing Address - Country:US
Mailing Address - Phone:210-382-6217
Mailing Address - Fax:210-451-7773
Practice Address - Street 1:602 31ST ST
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3512
Practice Address - Country:US
Practice Address - Phone:830-741-3361
Practice Address - Fax:830-426-8496
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4364207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138677308Medicaid
TX138677308Medicaid